García-Carro Clara, Vergara Ander, Agraz Irene, Jacobs-Cachá Conxita, Espinel Eugenia, Seron Daniel, Soler María José
Nephrology Research Group, Vall d'Hebron Research Institute (VHIR), Nephrology Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, 08035 Barcelona, Spain.
Red de Investigación Renal (REDINREN), Instituto Carlos IIIFEDER, 28029 Madrid, Spain.
J Clin Med. 2019 Jun 17;8(6):864. doi: 10.3390/jcm8060864.
Diabetic kidney disease (DKD) is the leading cause of end-stage renal disease in the developed world. Until 2016, the only treatment that was clearly demonstrated to delay the DKD was the renin-angiotensin system blockade, either by angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. However, this strategy only partially covered the DKD progression. Thus, new strategies for reno-cardiovascular protection in type 2 diabetic patients are urgently needed. In the last few years, hypoglycaemic drugs, such as sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, demonstrated a cardioprotective effect, mainly in terms of decreasing hospitalization for heart failure and cardiovascular death in type 2 diabetic patients. In addition, these drugs also demonstrated a clear renoprotective effect by delaying DKD progression and decreasing albuminuria. Another hypoglycaemic drug class, dipeptidyl peptidase 4 inhibitors, has been approved for its use in patients with advanced chronic kidney disease, avoiding, in part, the need for insulinization in this group of DKD patients. Studies in diabetic and non-diabetic experimental models suggest that these drugs may exert their reno-cardiovascular protective effect by glucose and non-glucose dependent mechanisms. This review focuses on newly demonstrated strategies that have shown reno-cardiovascular benefits in type 2 diabetes and that may change diabetes management algorithms.
糖尿病肾病（DKD）是发达国家终末期肾病的主要病因。直到2016年，唯一被明确证明可延缓DKD进展的治疗方法是肾素 - 血管紧张素系统阻断，即使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。然而，这一策略仅部分涵盖了DKD的进展。因此，迫切需要针对2型糖尿病患者的肾脏 - 心血管保护新策略。在过去几年中，降糖药物，如钠 - 葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽 - 1受体激动剂，显示出心脏保护作用，主要体现在减少2型糖尿病患者因心力衰竭住院和心血管死亡方面。此外，这些药物还通过延缓DKD进展和减少蛋白尿显示出明确的肾脏保护作用。另一类降糖药物，二肽基肽酶4抑制剂，已被批准用于晚期慢性肾病患者，部分避免了这组DKD患者使用胰岛素的必要性。在糖尿病和非糖尿病实验模型中的研究表明，这些药物可能通过葡萄糖依赖性和非葡萄糖依赖性机制发挥其肾脏 - 心血管保护作用。本综述重点关注新证明的在2型糖尿病中显示出肾脏 - 心血管益处且可能改变糖尿病管理算法的策略。
