Slowing the Progression of Chronic Kidney Disease in Patients with Type 2 Diabetes Using Four Pillars of Therapy: The Time to Act is Now

IF 13 1区 医学 Q1 PHARMACOLOGY & PHARMACY
Drugs Pub Date : 2024-09-11 DOI:10.1007/s40265-024-02091-8
Panagiotis I. Georgianos, Vasilios Vaios, Theocharis Koufakis, Vassilios Liakopoulos
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Abstract

Chronic kidney disease (CKD) is the most common co-morbidity in patients with type 2 diabetes (T2D) and its presence substantially amplifies the risk for premature death, adverse cardiovascular events, and faster progression of kidney injury to kidney failure. For nearly two decades, the pharmacological blockade of the renin-angiotensin-system (RAS) was the only pillar of therapy to afford cardiorenal protection in these patients. During the last 5 years, newer novel therapies have been added to our therapeutic armamentarium, offering promise for more effective management of diabetic kidney disease in the future. Large phase 3 clinical trials have demonstrated additive cardiorenal protective benefits of sodium-glucose co-transporter type 2 (SGLT-2) inhibitors, the non-steroidal mineralocorticoid-receptor-antagonist (MRA) finerenone, and glucagon-like peptide-1 receptor agonist (GLP-1RA) semaglutide relative to placebo in patients with albuminuric CKD and T2D who are receiving standard-of-care treatment with a RAS-blocker. These therapies are likely much more effective when administered in a combined therapeutic algorithm, but the potential additive effects of combination therapy remain to be established in ongoing clinical trials. In this article, we assemble four pillars of therapy for the attenuation of residual cardiorenal risk in patients with CKD associated with T2D. We provide evidence from recent randomized trials and we discuss the concept of combined treatment for maximal cardiorenal protection in this high-risk patient population.

利用四大支柱疗法减缓 2 型糖尿病患者慢性肾病的进展:行动就是现在
慢性肾病(CKD)是 2 型糖尿病(T2D)患者最常见的并发症,它的存在大大增加了患者过早死亡、发生不良心血管事件的风险,并加快了肾损伤向肾衰竭发展的速度。近二十年来,药物阻断肾素-血管紧张素系统(RAS)是为这些患者提供心肾保护的唯一治疗支柱。在过去的 5 年中,我们的治疗手段中加入了更新的新型疗法,为今后更有效地治疗糖尿病肾病带来了希望。大型三期临床试验证明,对于接受 RAS 受体阻滞剂标准治疗的白蛋白尿 CKD 和 T2D 患者,钠-葡萄糖协同转运体 2 型 (SGLT-2) 抑制剂、非甾体类矿物皮质激素受体拮抗剂 (MRA) 非格列酮、胰高血糖素样肽-1 受体激动剂 (GLP-1RA) 塞马鲁肽相对于安慰剂具有额外的心肾保护作用。如果采用联合治疗方案,这些疗法的疗效可能会更好,但联合疗法的潜在叠加效应仍有待正在进行的临床试验来确定。在本文中,我们总结了四大治疗支柱,以降低伴有 T2D 的 CKD 患者的残余心肾风险。我们提供了近期随机试验的证据,并讨论了在这一高风险患者群体中最大限度地保护心肾联合治疗的概念。
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来源期刊
Drugs
Drugs 医学-毒理学
CiteScore
22.70
自引率
0.90%
发文量
134
审稿时长
3-8 weeks
期刊介绍: Drugs is a journal that aims to enhance pharmacotherapy by publishing review and original research articles on key aspects of clinical pharmacology and therapeutics. The journal includes: Leading/current opinion articles providing an overview of contentious or emerging issues. Definitive reviews of drugs and drug classes, and their place in disease management. Therapy in Practice articles including recommendations for specific clinical situations. High-quality, well designed, original clinical research. Adis Drug Evaluations reviewing the properties and place in therapy of both newer and established drugs. AdisInsight Reports summarising development at first global approval. Moreover, the journal offers additional digital features such as animated abstracts, video abstracts, instructional videos, and podcasts to increase visibility and educational value. Plain language summaries accompany articles to assist readers with some knowledge of the field in understanding important medical advances.
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