Clements Jennifer N
Department of Nursing Administration, Spartanburg Regional Healthcare System, Spartanburg, SC, USA.
Drugs Context. 2022 Jun 14;11. doi: 10.7573/dic.2021-9-10. eCollection 2022.
Chronic kidney disease (CKD) is a prevalent and progressive condition worldwide, and diabetes is a leading risk factor of this renal disorder. People with diabetes and CKD are at high risk of complications such as cardiovascular events and death. CKD is often unrecognized and undiagnosed amongst people with diabetes. To manage CKD, multiple existing and newer agents have been studied in trials and recommended in clinical practice guidelines.
A narrative review of primary and/or secondary renal outcomes from randomized, controlled trials is summarized in this article. The main objective was to provide the most up-to-date information regarding existing and new pharmacotherapy for the management of CKD amongst people with diabetes, specifically type 2 diabetes (T2D).
Traditional agents, such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, have been used for 20 years to preserve kidney function. Other existing agents have received approval by the FDA for the management of CKD such as dapagliflozin, with a role in reducing intraglomerular pressure. Evidence with sodium-glucose cotransporter 2 inhibitors show a potential class effect on improving renal outcomes, independent on their effect on glycaemic parameters. Recently, finerenone was approved for people with T2D and CKD based on clinical evidence as a non-steroidal mineralocorticoid receptor antagonist. Overall, primary and secondary prevention trials have influenced changes in clinical practice guidelines regarding the use of existing and new pharmacotherapy for CKD. Additional considerations include lifestyle modifications, blood pressure management and achievement of glycaemic targets for people with diabetes and CKD, following adequate screening of glomerular filtration rate and/or severity of albuminuria.
Due to more robust evidence, clinical practice guidelines have been modified to reflect high-level recommendations for the management of CKD in people with diabetes, specifically T2D. Additional evidence is needed amongst people with lower glomerular filtration rates and in comparison with the standard of care.
慢性肾脏病（CKD）在全球范围内普遍存在且呈进行性发展，糖尿病是这种肾脏疾病的主要危险因素。糖尿病合并CKD患者发生心血管事件和死亡等并发症的风险很高。CKD在糖尿病患者中常常未被识别和诊断。为了管理CKD，多种现有及新型药物已在试验中进行研究，并在临床实践指南中得到推荐。
本文总结了对随机对照试验的主要和/或次要肾脏结局的叙述性综述。主要目的是提供有关糖尿病患者（特别是2型糖尿病（T2D）患者）管理CKD的现有和新药物治疗的最新信息。
传统药物，如血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂，已被用于保护肾功能20年。其他现有药物已获得美国食品药品监督管理局（FDA）批准用于管理CKD，如达格列净，其在降低肾小球内压方面有作用。钠-葡萄糖协同转运蛋白2抑制剂的证据显示，其对改善肾脏结局有潜在的类效应，独立于其对血糖参数的影响。最近，非奈利酮基于临床证据被批准用于T2D和CKD患者，作为一种非甾体类盐皮质激素受体拮抗剂。总体而言，一级和二级预防试验影响了临床实践指南中关于CKD现有和新药物治疗使用的变化。其他考虑因素包括生活方式改变、血压管理以及糖尿病和CKD患者在充分筛查肾小球滤过率和/或蛋白尿严重程度后实现血糖目标。
由于有更确凿的证据，临床实践指南已被修改，以反映对糖尿病患者（特别是T2D患者）CKD管理的高级别建议。肾小球滤过率较低的患者以及与标准治疗相比还需要更多证据。
