Assessment of renal and cardiovascular risks in patients with type 2 diabetes when using non-steroidal mineralocorticoid receptor antagonists

Viktoriia Yerokhovych, Y. Komisarenko, O.V. Karpenko, V.I. Pankiv, N.M. Kobyliak, M. Bobryk, D.V. Kyriienko, K. Gurska, A.A. Kaplina, V.L. Vasiuk
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Abstract

Background. Given the proven excessive activation of the renin-angiotensin-aldosterone system and the clinical manifestations of hypertension, mostly of renal origin, there is a need to optimize antihypertensive therapy aimed at an active nephroprotection. The purpose of the study is to carry out a comprehensive assessment of kidney and heart risk factors in patients with type 2 diabetes mellitus and chronic kidney disease (CKD) and to justify the administration of non-steroidal mineralocorticoid receptor antagonists to these patients. Materials and methods. In a prospective cohort study, 88 patients with type 2 diabetes were examined: group 1 — estimated glomerular filtration rate (eGFR) < 60 ml/min/m2, group 2 — eGFR ≥ 60 ml/min/m2. eGFR was evaluated according to the CKD-EPI (Chronic Kidney Disease Epidemiology Colla­boration) formula based on serum creatinine. GFR category was defined according to the KDIGO (Kidney Disease: Improving Global Outcomes) criteria. The albumin-creatinine ratio was calcula­ted. The level of glycated hemoglobin (HbA1c) was assessed by the method of high-performance liquid chromatography. Aldosterone was evaluated by immunoenzymatic method. Results. In patients with eGFR < 60 ml/min/m2, the albumin-creatinine ratio in daily urine is statistically significantly higher compared to group 2. Patients with eGFR < 60 ml/min/m2 had an average uric acid level of 410.3 ± 98.8 μmol/l, which is statistically significantly higher than in those with eGFR ≥ 60 ml/min/m2 — 321.10 ± 74.54 μmol/l. A statistically significant correlation between the level of uric acid and markers of renal dysfunction was found only in patients with eGFR < 60 ml/min/m2. Aldosterone levels were higher in the first group. No statistical difference was found between the average value of HbA1c in the studied groups. Conclusions. Numerous factors of unfavorable prognosis regarding kidney and heart risks have been identified: hypertension, increased albumin-creatinine ratio and cholesterol, unsatisfactory compensation of diabetes, obesity. There is an increase in the frequency of resistant hypertension, hyperuricemia, and hyperaldosteronism in patients with decreased eGFR. In patients with diabetic kidney damage on the background of type 2 diabetes, the administration of finerenone, a non-steroidal mine­ralocorticoid receptor antagonist, at a dose of 10–20 mg/day is pathogenetically justified.
评估 2 型糖尿病患者使用非甾体类矿物质皮质激素受体拮抗剂时的肾脏和心血管风险
背景。鉴于肾素-血管紧张素-醛固酮系统已被证实过度激活,且高血压的临床表现大多源于肾脏,因此有必要优化降压治疗,以积极保护肾脏。本研究旨在对 2 型糖尿病和慢性肾脏病(CKD)患者的肾脏和心脏风险因素进行全面评估,并为这些患者使用非甾体类矿物质皮质激素受体拮抗剂提供依据。材料和方法。在一项前瞻性队列研究中,88 名 2 型糖尿病患者接受了检查:第 1 组--估计肾小球滤过率(eGFR)< 60 ml/min/m2;第 2 组--eGFR ≥ 60 ml/min/m2。eGFR 根据基于血清肌酐的 CKD-EPI(慢性肾脏病流行病学协作组)公式进行评估。GFR 类别是根据 KDIGO(肾脏疾病:改善全球预后)标准定义的。计算白蛋白-肌酐比值。糖化血红蛋白(HbA1c)水平采用高效液相色谱法进行评估。醛固酮采用免疫酶法进行评估。结果显示在 eGFR < 60 ml/min/m2 的患者中,每日尿液中的白蛋白-肌酐比值在统计学上明显高于第 2 组。eGFR < 60 ml/min/m2 患者的平均尿酸水平为 410.3 ± 98.8 μmol/l,在统计学上明显高于 eGFR ≥ 60 ml/min/m2 的患者 - 321.10 ± 74.54 μmol/l。只有在 eGFR < 60 ml/min/m2 的患者中,尿酸水平与肾功能障碍指标之间才存在统计学意义上的明显相关性。第一组患者的醛固酮水平较高。研究组的 HbA1c 平均值之间没有统计学差异。结论在肾脏和心脏风险方面发现了许多不利预后的因素:高血压、白蛋白-肌酐比值和胆固醇升高、糖尿病补偿效果不理想、肥胖。抵抗性高血压、高尿酸血症和高醛固酮症在 eGFR 下降的患者中出现的频率增加。对于在 2 型糖尿病背景下出现糖尿病肾损害的患者,非甾体类矿物质皮质激素受体拮抗剂非格列酮(fineerenone)的用药剂量为 10-20 毫克/天,在病理上是合理的。
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