SGLT2 Inhibitors and GLP-1 Receptor Agonists in Diabetic Kidney Disease: Evolving Evidence and Clinical Application.

IF 6.8 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Jae Hyun Bae
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Abstract

Diabetic kidney disease (DKD) is a leading cause of end-stage kidney disease and significantly increases cardiovascular risk and mortality. Despite conventional therapies, including renin-angiotensin-aldosterone system inhibitors, substantial residual risk remains. The emergence of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists has reshaped DKD management. Beyond glycemic control, these agents provide distinct and complementary cardiorenal benefits through mechanisms such as hemodynamic modulation, anti-inflammatory effects, and metabolic adaptations. Landmark trials, including CREDENCE, DAPA-CKD, EMPA-KIDNEY, and FLOW, have demonstrated their efficacy in preserving kidney function and reducing adverse outcomes. SGLT2 inhibitors appear more effective in mitigating glomerular hyperfiltration and lowering heart failure risk, whereas GLP-1 receptor agonists are particularly beneficial in reducing albuminuria and atherosclerotic cardiovascular events. Although indirect comparisons suggest that SGLT2 inhibitors may offer greater protection against kidney function decline, direct head-to-head trials are lacking. Combination therapy holds promise, however further studies are needed to define optimal treatment strategies. This review synthesizes current evidence, evaluates comparative effectiveness, and outlines future directions in DKD management, emphasizing precision medicine approaches to enhance clinical outcomes. The integration of these therapies represents a paradigm shift in diabetes care, expanding treatment options for people with diabetes mellitus at risk of kidney failure.

糖尿病肾病的SGLT2抑制剂和GLP-1受体激动剂:不断发展的证据和临床应用
糖尿病肾病(DKD)是终末期肾脏疾病的主要原因,并显著增加心血管风险和死亡率。尽管采用常规疗法,包括肾素-血管紧张素-醛固酮系统抑制剂,但仍存在大量残留风险。钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂和胰高血糖素样肽-1 (GLP-1)受体激动剂的出现重塑了DKD的管理。除了血糖控制外,这些药物还通过血流动力学调节、抗炎作用和代谢适应等机制提供独特和互补的心肾益处。具有里程碑意义的试验,包括CREDENCE、DAPA-CKD、EMPA-KIDNEY和FLOW,已经证明了它们在保护肾功能和减少不良后果方面的功效。SGLT2抑制剂似乎在减轻肾小球高滤过和降低心力衰竭风险方面更有效,而GLP-1受体激动剂在减少蛋白尿和动脉粥样硬化性心血管事件方面特别有益。虽然间接比较表明SGLT2抑制剂可能对肾功能下降提供更大的保护,但缺乏直接的头对头试验。联合治疗有希望,但需要进一步的研究来确定最佳的治疗策略。这篇综述综合了目前的证据,评估了比较有效性,并概述了DKD管理的未来方向,强调了精确医学方法来提高临床结果。这些疗法的整合代表了糖尿病护理的范式转变,扩大了有肾衰竭风险的糖尿病患者的治疗选择。
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来源期刊
Diabetes & Metabolism Journal
Diabetes & Metabolism Journal Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
10.40
自引率
6.80%
发文量
92
审稿时长
52 weeks
期刊介绍: The aims of the Diabetes & Metabolism Journal are to contribute to the cure of and education about diabetes mellitus, and the advancement of diabetology through the sharing of scientific information on the latest developments in diabetology among members of the Korean Diabetes Association and other international societies. The Journal publishes articles on basic and clinical studies, focusing on areas such as metabolism, epidemiology, pathogenesis, complications, and treatments relevant to diabetes mellitus. It also publishes articles covering obesity and cardiovascular disease. Articles on translational research and timely issues including ubiquitous care or new technology in the management of diabetes and metabolic disorders are welcome. In addition, genome research, meta-analysis, and randomized controlled studies are welcome for publication. The editorial board invites articles from international research or clinical study groups. Publication is determined by the editors and peer reviewers, who are experts in their specific fields of diabetology.
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