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慢性肾脏病患者新疗法的最新进展。

Updates on New Therapies for Patients with CKD.

作者信息

Tarun Tushar, Ghanta Sai Nikhila, Ong Vincz, Kore Rajshekhar, Menon Lakshmi, Kovesdy Csaba, Mehta Jawahar L, Jain Nishank

机构信息

Division of Cardiology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

出版信息

Kidney Int Rep. 2023 Oct 12;9(1):16-28. doi: 10.1016/j.ekir.2023.10.006. eCollection 2024 Jan.

Abstract

Individuals diagnosed with chronic kidney disease (CKD) continue to increase globally. This group of patients experience a disproportionately higher risk of cardiovascular (CV) events compared to the general population. Despite multiple guidelines-based medical management, patients with CKD continue to experience residual cardiorenal risk. Several potential mechanisms explain this excessive CV risk observed in individuals with CKD. Several new drugs have become available that could potentially transform CKD care, given their efficacy in this patient population. Nevertheless, use of these drugs presents certain benefits and challenges that are often underrecognized by prescribing these drugs. In this review, we aim to provide a brief discussion about CKD pathophysiology, limiting our discussion to recent published studies. We also explore benefits and limitations of newer drugs, including angiotensin receptor/neprilysin inhibitors (ARNI), sodium glucose transporter 2 inhibitors (SGLT2i), glucagon-like peptides-1 (GLP-1) agonists and finerenone in patients with CKD. Despite several articles covering this topic, our review provides an algorithm where subgroups of patients with CKD might benefit the most from such drugs based on the selection criteria of the landmark trials. Patients with CKD who have nephrotic range proteinuria beyond 5000 mg/g, or those with poorly controlled blood pressure (systolic ≥160 mm Hg or diastolic ≥100 mm Hg) remain understudied.

摘要

全球范围内,被诊断为慢性肾脏病(CKD)的人数持续增加。与普通人群相比,这组患者发生心血管(CV)事件的风险要高得多。尽管采取了多种基于指南的药物治疗,但CKD患者仍存在残余的心肾风险。有几种潜在机制可以解释在CKD患者中观察到的这种过高的CV风险。鉴于几种新药在该患者群体中的疗效,它们有可能改变CKD的治疗方式。然而,使用这些药物存在一定的益处和挑战,而在开具这些药物处方时,这些往往未得到充分认识。在本综述中,我们旨在简要讨论CKD的病理生理学,将讨论限于最近发表的研究。我们还探讨了新药的益处和局限性,包括血管紧张素受体/脑啡肽酶抑制剂(ARNI)、钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)、胰高血糖素样肽-1(GLP-1)激动剂和非奈利酮在CKD患者中的应用。尽管有几篇文章涉及这个主题,但我们的综述提供了一种算法,根据标志性试验的选择标准,CKD患者亚组可能从这些药物中获益最大。尿蛋白范围超过5000mg/g的CKD患者,或血压控制不佳(收缩压≥160mmHg或舒张压≥100mmHg)的患者,仍未得到充分研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/6cf9/10831355/4f0943d3f319/gr1.jpg

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