Psyllaki Anna, Tziomalos Konstantinos
The First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece.
World J Diabetes. 2024 Jun 15;15(6):1086-1090. doi: 10.4239/wjd.v15.i6.1086.
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease and is also associated with increased risk for cardiovascular events. Until recently, strict glycemic control and blockade of the renin-angiotensin system (RAS) constituted the mainstay of treatment of DN. However, randomized controlled trials showed that sodium-glucose cotransporter 2 inhibitors further reduce the progression of DN. Therefore, these agents are recommended in all patients with DN regardless of DN stage and HbA levels. Moreover, additional blockade of the RAS with finerenone, a selective non-steroidal mineralocorticoid receptor antagonist, was also shown to prevent both the decline of renal function and cardiovascular events in this population. Finally, promising preliminary findings suggest that glucagon-like peptide 1 receptor agonists might also exert reno- and cardioprotective effects in patients with DN. Hopefully, this knowledge will improve the outcomes of this high-risk group of patients.
糖尿病肾病(DN)是终末期肾病的主要病因,还与心血管事件风险增加相关。直到最近,严格的血糖控制和肾素 - 血管紧张素系统(RAS)阻断仍是DN治疗的主要手段。然而,随机对照试验表明,钠 - 葡萄糖协同转运蛋白2抑制剂可进一步减缓DN的进展。因此,无论DN处于何种阶段以及糖化血红蛋白(HbA)水平如何,所有DN患者均推荐使用这些药物。此外,使用非奈利酮(一种选择性非甾体盐皮质激素受体拮抗剂)额外阻断RAS,也被证明可预防该人群的肾功能下降和心血管事件。最后,有前景的初步研究结果表明,胰高血糖素样肽1受体激动剂可能对DN患者也具有肾脏和心脏保护作用。有望这些知识能改善这一高危患者群体的治疗结局。
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