Di Lullo Luca, Mangano Michela, Ronco Claudio, Barbera Vincenzo, De Pascalis Antonio, Bellasi Antonio, Russo Domenico, Di Iorio Biagio, Cozzolino Mario
Department of Nephrology and Dialysis, L. Parodi - Delfino Hospital, Colleferro, Italy.
Department of Health Sciences, S. Paolo Hospital, University of Milan, Italy.
Diabetes Metab Syndr. 2017 Nov;11 Suppl 1:S295-S305. doi: 10.1016/j.dsx.2017.03.005. Epub 2017 Mar 6.
Worldwide, an estimated 200 million people have chronic kidney disease (CKD), whose most common causes include hypertension, arteriosclerosis, and diabetes. About 40% of patients with diabetes develop CKD and intensive blood glucose control through pharmacological intervention can delay CKD progression. Standard therapies for the treatment of type 2 diabetes mellitus include metformin, sulfonylureas, meglitinides, thiazolidinediones, and insulin. While these drugs have an important role in the management of type 2 diabetes, only the thiazolidinedione pioglitazone can be used across the spectrum of CKD (stages 2-5) and without dose adjustment. Newer therapies, particularly dipeptidyl peptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter-2 inhibitors, are increasingly being used in the treatment of type 2 diabetes; however, a major consideration is whether these newer therapies can also be used safely and effectively across the spectrum of renal impairment.
全球估计有2亿人患有慢性肾脏病（CKD），其最常见的病因包括高血压、动脉硬化和糖尿病。约40%的糖尿病患者会发展为CKD，通过药物干预强化血糖控制可延缓CKD进展。2型糖尿病的标准治疗方法包括二甲双胍、磺脲类药物、格列奈类药物、噻唑烷二酮类药物和胰岛素。虽然这些药物在2型糖尿病的管理中发挥着重要作用，但只有噻唑烷二酮类药物吡格列酮可在整个CKD范围（2 - 5期）使用且无需调整剂量。新型疗法，特别是二肽基肽酶 - 4抑制剂、胰高血糖素样肽 - 1受体激动剂和钠 - 葡萄糖协同转运蛋白 - 2抑制剂，越来越多地用于治疗2型糖尿病；然而，一个主要的考虑因素是这些新型疗法是否也能在整个肾功能损害范围内安全有效地使用。
