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慢性肾脏病中糖尿病治疗药物的重新利用:钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽-1受体激动剂的作用机制、临床疗效及安全性

Repurposing Diabetes Therapies in CKD: Mechanistic Insights, Clinical Outcomes and Safety of SGLT2i and GLP-1 RAs.

作者信息

Rabbani Syed Arman, El-Tanani Mohamed, Kumar Rakesh, Saini Manita, El-Tanani Yahia, Sharma Shrestha, Aljabali Alaa A A, Hajeer Eman, Rizzo Manfredi

机构信息

RAK College of Pharmacy, RAK Medical and Health Sciences University, Ras Al Khaimah 11172, United Arab Emirates.

Amity Institute of Pharmacy, Amity University, Gurgaon 122413, Haryana, India.

出版信息

Pharmaceuticals (Basel). 2025 Jul 28;18(8):1130. doi: 10.3390/ph18081130.

Abstract

Chronic Kidney Disease (CKD) is a major global health issue, with diabetes being its primary cause and cardiovascular disease contributing significantly to patient mortality. Recently, two classes of medications-sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs)-have shown promise in protecting both kidney and heart health beyond their effects on blood sugar control. We conducted a narrative review summarizing the findings of different clinical trials and mechanistic studies evaluating the effect of SGLT2i and GLP-1 RAs on kidney function, cardiovascular outcomes, and overall disease progression in patients with CKD and DKD. SGLT2i significantly mitigate kidney injury by restoring tubuloglomerular feedback, reducing intraglomerular hypertension, and attenuating inflammation, fibrosis, and oxidative stress. GLP-1 RAs complement these effects by enhancing endothelial function, promoting weight and blood pressure control, and exerting direct anti-inflammatory and anti-fibrotic actions on renal tissues. Landmark trials-CREDENCE, DAPA-CKD, and EMPA-KIDNEY-demonstrate that SGLT2i reduce the risk of kidney failure and renal or cardiovascular death by 25-40% in both diabetic and non-diabetic CKD populations. Likewise, trials such as LEADER, SUSTAIN, and AWARD-7 confirm that GLP-1 RAs slow renal function decline and improve cardiovascular outcomes. Early evidence suggests that using both drugs together may offer even greater benefits through multiple mechanisms. SGLT2i and GLP-1 RAs have redefined the therapeutic landscape of CKD by offering organ-protective benefits that extend beyond glycemic control. Whether used individually or in combination, these agents represent a paradigm shift toward integrated cardiorenal-metabolic care. A deeper understanding of their mechanisms and clinical utility in both diabetic and non-diabetic populations can inform evidence-based strategies to slow disease progression, reduce cardiovascular risk, and improve long-term patient outcomes in CKD.

摘要

慢性肾脏病(CKD)是一个重大的全球健康问题,糖尿病是其主要病因,心血管疾病是导致患者死亡的重要因素。最近,两类药物——钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)和胰高血糖素样肽-1受体激动剂(GLP-1 RAs)——已显示出在控制血糖之外对肾脏和心脏健康具有保护作用。我们进行了一项叙述性综述,总结了不同临床试验和机制研究的结果,这些研究评估了SGLT2i和GLP-1 RAs对CKD和糖尿病肾病(DKD)患者肾功能、心血管结局和整体疾病进展的影响。SGLT2i通过恢复肾小管-肾小球反馈、降低肾小球内高压以及减轻炎症、纤维化和氧化应激,显著减轻肾脏损伤。GLP-1 RAs通过增强内皮功能、促进体重和血压控制以及对肾组织发挥直接的抗炎和抗纤维化作用来补充这些效果。具有里程碑意义的试验——CREDENCE、DAPA-CKD和EMPA-KIDNEY——表明,SGLT2i可使糖尿病和非糖尿病CKD人群的肾衰竭风险以及肾脏或心血管死亡风险降低25%至40%。同样,LEADER、SUSTAIN和AWARD-7等试验证实,GLP-1 RAs可减缓肾功能下降并改善心血管结局。早期证据表明,联合使用这两种药物可能通过多种机制带来更大益处。SGLT2i和GLP-1 RAs通过提供超越血糖控制的器官保护益处,重新定义了CKD的治疗格局。无论单独使用还是联合使用,这些药物都代表了向心脏-肾脏-代谢综合护理的范式转变。深入了解它们在糖尿病和非糖尿病人群中的作用机制和临床应用,可为减缓疾病进展、降低心血管风险以及改善CKD患者长期结局的循证策略提供依据。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f51f/12389137/dfee86b64f33/pharmaceuticals-18-01130-g001.jpg

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