Mallik Ritwika, Chowdhury Tahseen A
Department of Diabetes and Metabolism, The Royal London Hospital, London, UK.
Department of Diabetes and Metabolism, The Royal London Hospital, 7th Floor, John Harrison House, Whitechapel, London E1 1BB, UK.
Ther Adv Endocrinol Metab. 2022 Mar 4;13:20420188221081601. doi: 10.1177/20420188221081601. eCollection 2022.
Diabetic kidney disease (DKD) is a leading cause of morbidity and mortality among people living with diabetes, and is one of the most important causes of end stage renal disease worldwide. In order to reduce progression of DKD, important management goals include treatment of hypertension, glycaemia and control of cardiovascular risk factors such as lipids, diet, smoking and exercise. Use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers has an established role in prevention of progression of DKD. A number of other agents such as endothelin-1 receptor antagonists and bardoxolone have had disappointing results. Recent studies have, however, suggested that newer antidiabetic agents such as sodium-glucose transporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 analogues have specific beneficial effects in patients with DKD. Indeed most recent guidance suggest that SGLT-2i drugs should be used early in DKD, irrespective of glucose control. A number of pathways are hypothesised for the development and progression of DKD, and have opened up a number of newer potential therapeutic targets. This article aims to discuss management of DKD with respect to seminal trials from the past, more recent trials informing the present and potential new therapeutic options that may be available in the future.
糖尿病肾病（DKD）是糖尿病患者发病和死亡的主要原因之一，也是全球终末期肾病的最重要原因之一。为了减缓DKD的进展，重要的管理目标包括治疗高血压、控制血糖以及控制心血管危险因素，如血脂、饮食、吸烟和运动。使用血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂在预防DKD进展方面已确立了作用。许多其他药物，如内皮素-1受体拮抗剂和巴多索隆，效果并不理想。然而，最近的研究表明，新型抗糖尿病药物，如钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i）和胰高血糖素样肽-1类似物，对DKD患者具有特定的有益作用。事实上，最新指南建议，无论血糖控制情况如何，SGLT-2i药物都应在DKD早期使用。关于DKD的发生和进展有多种假说途径，这也开辟了许多新的潜在治疗靶点。本文旨在讨论DKD的管理，涉及过去的重要试验、为当前提供信息的近期试验以及未来可能出现的潜在新治疗选择。
