Clinical Research Services, Mannheim GmbH, Grenadierstrasse 1, D-68167, Mannheim, Germany.
Department of Endocrinology, UZ Gasthuisberg, Katholieke Universiteit, Leuven, Belgium.
BMC Med. 2022 Oct 10;20(1):337. doi: 10.1186/s12916-022-02539-2.
Diabetic kidney disease (DKD), the most common cause of kidney failure and end-stage kidney disease worldwide, will develop in almost half of all people with type 2 diabetes. With the incidence of type 2 diabetes continuing to increase, early detection and management of DKD is of great clinical importance.
This review provides a comprehensive clinical update for DKD in people with type 2 diabetes, with a special focus on new treatment modalities. The traditional strategies for prevention and treatment of DKD, i.e., glycemic control and blood pressure management, have only modest effects on minimizing glomerular filtration rate decline or progression to end-stage kidney disease. While cardiovascular outcome trials of SGLT-2i show a positive effect of SGLT-2i on several kidney disease-related endpoints, the effect of GLP-1 RA on kidney-disease endpoints other than reduced albuminuria remain to be established. Non-steroidal mineralocorticoid receptor antagonists also evoke cardiovascular and kidney protective effects.
With these new agents and the promise of additional agents under clinical development, clinicians will be more able to personalize treatment of DKD in patients with type 2 diabetes.
糖尿病肾病（DKD）是全球范围内导致肾衰竭和终末期肾病的最常见病因，几乎所有 2 型糖尿病患者中都会发生。随着 2 型糖尿病的发病率持续上升，早期发现和管理 DKD 具有重要的临床意义。
本文对 2 型糖尿病患者的 DKD 进行了全面的临床更新，特别关注新的治疗方法。预防和治疗 DKD 的传统策略，即血糖控制和血压管理，对减缓肾小球滤过率下降或进展为终末期肾病的效果有限。SGLT-2i 的心血管结局试验表明 SGLT-2i 对几个与肾脏疾病相关的终点有积极影响，但 GLP-1RA 对除减少白蛋白尿以外的肾脏疾病终点的影响仍有待确定。非甾体类盐皮质激素受体拮抗剂也具有心血管和肾脏保护作用。
随着这些新药物的出现，以及更多正在临床开发中的药物的出现，临床医生将能够更好地为 2 型糖尿病患者的 DKD 进行个体化治疗。
