Rojano Toimil Alba, Ciudin Andreea
Endocrinology and Nutrition Department, Hospital Universitari Vall Hebron, 08035 Barcelona, Spain.
Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona (VHIR-UAB), 08916 Barcelona, Spain.
J Clin Med. 2021 Aug 31;10(17):3955. doi: 10.3390/jcm10173955.
Diabetic kidney disease (DKD) is one of the most common complications in type 2 diabetes mellitus (T2D) and a major cause of morbidity and mortality in diabetes. Despite the widespread use of nephroprotective treatment of T2D, the incidence of DKD is increasing, and it is expected to become the fifth cause of death worldwide within 20 years. Previous studies have demonstrated that GLP-1 receptor agonists (GLP-1 RA) have improved macrovascular and microvascular outcomes independent of glycemic differences, including DKD. GLP-1Ras' improvement on kidney physiology is mediated by natriuresis, reduction in hyperfiltration and renin-angiotensin-aldosterone system (RAAS) activity and anti-inflammatory properties. These findings translate into improved clinical outcomes such as an enhanced urine albumin-to-creatinine ratio (UACR) and a reduction in renal impairment and the need for renal replacement therapies (RRT). In this article, we review the role of GLP-1RAs on the mechanisms and effect in DKD and their clinical efficacy.
糖尿病肾病（DKD）是2型糖尿病（T2D）最常见的并发症之一，也是糖尿病发病和死亡的主要原因。尽管T2D的肾脏保护治疗已广泛应用，但DKD的发病率仍在上升，预计20年内将成为全球第五大死因。既往研究表明，胰高血糖素样肽-1受体激动剂（GLP-1 RA）可改善大血管和微血管结局，与血糖差异无关，包括DKD。GLP-1 RA对肾脏生理功能的改善是通过利钠作用、减少超滤和肾素-血管紧张素-醛固酮系统（RAAS）活性以及抗炎特性介导的。这些发现转化为改善的临床结局，如尿白蛋白与肌酐比值（UACR）升高、肾功能损害减轻以及肾脏替代治疗（RRT）需求减少。在本文中，我们综述了GLP-1 RA在DKD中的作用机制、效果及其临床疗效。
