De Nicola Luca, Cupisti Adamasco, D'Alessandro Claudia, Gesualdo Loreto, Santoro Domenico, Bellizzi Vincenzo
Nephrology and Dialysis Div., Dept. Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
J Nephrol. 2025 Jan;38(1):61-73. doi: 10.1007/s40620-024-02135-y. Epub 2024 Nov 7.
Chronic kidney disease (CKD) is widely recognized as a leading and growing contributor to global morbidity and mortality worldwide. Nutritional therapy is the basic treatment for metabolic control, and may contribute to nephroprotection; however, the absence of solid evidence on slowing CKD progression together with poor adherence to dietary prescription limit de facto its efficacy and prevent its more widespread use. Sodium-glucose transport protein 2 inhibitors (SGLT2is) are now considered the new standard of care in CKD; in addition, novel potassium binders, glucagon-like peptide-1 receptor antagonists (GLP1-RAs) and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) show either direct (SGLT2i, GLP1-RA, nsMRA) or indirect (potassium binders that enable the optimal use of renin-angiotensin-aldosterone system inhibitors) nephroprotective effects. These drugs could potentially lead to a more permissive diet, thereby allowing the patient to reap the benefits of this approach. In particular, SGLT2is, and to a lesser extent also GLP1-RAs and nsMRAs in patients with diabetic kidney disease, can counterbalance hyperfiltration as well as the higher protein intake often recorded in obese patients; on the other hand, potassium binders can facilitate following plant-based diets, which are considered healthy because of the high content of essential micronutrients such as antioxidant vitamins, minerals, alkalies, and fibers. In this review paper, we discuss the current pharmacological paradigm shift that places a new, broader standard of care in light of its interaction with nutritional therapy in order to optimize the global approach to patients with CKD not on dialysis.
慢性肾脏病（CKD）被广泛认为是全球发病率和死亡率的主要且不断上升的因素。营养治疗是代谢控制的基本治疗方法，可能有助于肾脏保护；然而，缺乏关于减缓CKD进展的确凿证据，以及对饮食处方的依从性差，事实上限制了其疗效，并阻碍了其更广泛的应用。钠-葡萄糖转运蛋白2抑制剂（SGLT2i）现在被认为是CKD治疗的新标准；此外，新型钾结合剂、胰高血糖素样肽-1受体拮抗剂（GLP1-RA）和非甾体盐皮质激素受体拮抗剂（nsMRA）显示出直接（SGLT2i、GLP1-RA、nsMRA）或间接（钾结合剂可使肾素-血管紧张素-醛固酮系统抑制剂得到最佳使用）的肾脏保护作用。这些药物可能会使饮食限制更宽松，从而使患者受益。特别是，SGLT2i，以及在糖尿病肾病患者中程度较轻的GLP1-RA和nsMRA，可以抵消超滤以及肥胖患者中经常记录到的较高蛋白质摄入量；另一方面，钾结合剂可以促进遵循以植物为基础的饮食，这种饮食因其富含抗氧化维生素、矿物质、碱和纤维等必需微量营养素而被认为是健康的。在这篇综述文章中，我们讨论了当前的药理学范式转变，鉴于其与营养治疗的相互作用，提出了一个新的、更广泛的治疗标准，以优化对非透析CKD患者的整体治疗方法。
