Tong Li-Li, Adler Sharon G
Division of Nephrology and Hypertension, The Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
Kidney Res Clin Pract. 2022 Sep;41(Suppl 2):S63-S73. doi: 10.23876/j.krcp.21.288. Epub 2022 Sep 30.
Diabetic kidney disease (DKD) is the leading cause of chronic kidney disease and end-stage kidney disease worldwide, as the obesity epidemic and the burden of diabetes continue to rise globally. In general, guideline management of patients with DKD recommends lifestyle modifications, blood pressure and glycemic control, and dyslipidemia treatment along with other cardiovascular disease risk reduction measures. The inhibition of the renin-angiotensin system (RAS) using an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker remains the foundational therapy for DKD. In type 2 diabetes (T2D), significant advances in therapeutics, including the sodium-glucose cotransporter-2 inhibitors (SGLT2i), the glucagon-like peptide-1 receptor agonists (GLP-1 RA), and the nonsteroidal mineralocorticoid receptor agonist (MRA) finerenone, have dramatically expanded the armamentarium for treating DKD and its cardiovascular complications. Initiating, optimizing, and sustaining evidence-based pharmacological therapy using a therapeutic combination of RAS inhibitor + SGLT2i/GLP-1 RA + nonsteroidal MRA + statin is likely to significantly improve outcomes for T2D with DKD. Research into potential novel therapeutic targets for DKD remains particularly active and brings much anticipation and optimism to this field.
糖尿病肾病（DKD）是全球慢性肾脏病和终末期肾病的主要病因，因为全球肥胖流行率和糖尿病负担持续上升。一般来说，DKD患者的指南管理建议进行生活方式调整、控制血压和血糖以及治疗血脂异常，同时采取其他降低心血管疾病风险的措施。使用血管紧张素转换酶抑制剂或血管紧张素II受体阻滞剂抑制肾素-血管紧张素系统（RAS）仍然是DKD的基础治疗方法。在2型糖尿病（T2D）中，治疗方面取得了重大进展，包括钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）、胰高血糖素样肽1受体激动剂（GLP-1 RA）和非甾体盐皮质激素受体激动剂（MRA）非奈利酮，极大地扩展了治疗DKD及其心血管并发症的手段。使用RAS抑制剂+SGLT2i/GLP-1 RA+非甾体MRA+他汀类药物的治疗组合启动、优化和维持循证药物治疗，可能会显著改善T2D合并DKD患者的预后。对DKD潜在新治疗靶点的研究仍然非常活跃，给该领域带来了很多期待和乐观情绪。
