Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Nephrol Dial Transplant. 2019 Feb 1;34(2):208-230. doi: 10.1093/ndt/gfy407.
Chronic kidney disease (CKD) in patients with diabetes mellitus (DM) is a major problem of public health. Currently, many of these patients experience progression of cardiovascular and renal disease, even when receiving optimal treatment. In previous years, several new drug classes for the treatment of type 2 DM have emerged, including inhibitors of renal sodium-glucose co-transporter-2 (SGLT-2) and glucagon-like peptide-1 (GLP-1) receptor agonists. Apart from reducing glycaemia, these classes were reported to have other beneficial effects for the cardiovascular and renal systems, such as weight loss and blood pressure reduction. Most importantly, in contrast to all previous studies with anti-diabetic agents, a series of recent randomized, placebo-controlled outcome trials showed that SGLT-2 inhibitors and GLP-1 receptor agonists are able to reduce cardiovascular events and all-cause mortality, as well as progression of renal disease, in patients with type 2 DM. This document presents in detail the available evidence on the cardioprotective and nephroprotective effects of SGLT-2 inhibitors and GLP-1 analogues, analyses the potential mechanisms involved in these actions and discusses their place in the treatment of patients with CKD and DM.
糖尿病患者的慢性肾脏病 (CKD) 是一个主要的公共卫生问题。目前,尽管这些患者接受了最佳治疗,但许多人仍会出现心血管和肾脏疾病的进展。在过去几年中,出现了几种新的 2 型糖尿病治疗药物类别,包括肾钠-葡萄糖共转运蛋白-2(SGLT-2)抑制剂和胰高血糖素样肽-1(GLP-1)受体激动剂。除了降低血糖外,这些类别还被报道对心血管和肾脏系统具有其他有益作用,例如减轻体重和降低血压。最重要的是,与所有以前的糖尿病药物研究不同,一系列最近的随机、安慰剂对照结局试验表明,SGLT-2 抑制剂和 GLP-1 受体激动剂能够降低 2 型糖尿病患者的心血管事件和全因死亡率以及肾脏疾病的进展。本文详细介绍了 SGLT-2 抑制剂和 GLP-1 类似物的心脏保护和肾脏保护作用的现有证据,分析了这些作用涉及的潜在机制,并讨论了它们在治疗 CKD 和 DM 患者中的地位。
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