慢性肾脏病钠-葡萄糖共转运体-2 抑制剂的实际考虑因素和应用:谁、何时、如何使用?肾病学家的立场声明。

IF 3 Q1 PRIMARY HEALTH CARE
Anjay Rastogi, Ashté Collins, Ellie Kelepouris, Wayne Kotzker, John P Middleton, Minesh Rajpal, Prabir Roy-Chaudhury, Glenn M Chertow
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引用次数: 0

摘要

导言:降低慢性肾脏病(CKD)患者肾脏和心血管风险的需求仍未得到满足。因此,本报告旨在为初级保健提供者提供关于钠-葡萄糖协同转运体-2(SGLT2)抑制剂在慢性肾脏病患者中应用的实际临床指导,重点关注实际注意事项。SGLT2 抑制剂最初是作为降糖药物开发的,它可以保护肾功能,降低心血管事件和死亡率的风险。SGLT2抑制剂对慢性肾脏病的临床益处已在多项临床试验中得到证实,但在实际应用中的使用率仍然相对较低,这可能是由于标注适应症(过去和现在)的复杂性以及对SGLT2抑制剂作为一类药物的误解:由 8 位美国肾病专家组成的小组于 2022 年 8 月召开会议,围绕 CKD 患者的风险评估以及 SGLT2 抑制剂的启动和实施,为初级保健社区制定共识指南。在此,我们提供了《肾脏病:改善全球结局》(KDIGO)热图的改编版和治疗决策算法:我们主张将 SGLT2 抑制剂作为肾素-血管紧张素-醛固酮系统(RAAS)抑制剂的联合一线疗法,在开始使用 SGLT2 抑制剂之前无需完成 RAAS 抑制剂的剂量滴定。事实上,SGLT2 抑制剂治疗可促进 RAAS 抑制剂剂量的提升或维持。我们介绍了在临床实践中帮助实施 SGLT2 抑制剂的潜在策略,包括加强对医疗服务提供者和患者的教育和宣传,消除对 SGLT2 抑制剂安全性的误解。总之,我们支持将 SGLT2 抑制剂与 RAAS 抑制剂作为大多数慢性肾脏病患者的联合一线疗法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Practical Considerations and Implementation of Sodium-Glucose Co-Transporter-2 Inhibitors in Chronic Kidney Disease: Who, When, and How? A Position Statement by Nephrologists.

Introduction: There remains an unmet need to reduce kidney and cardiovascular risk in patients with chronic kidney disease (CKD). This report is therefore intended to provide real-world clinical guidance to primary care providers on sodium-glucose co-transporter-2 (SGLT2) inhibitor use in patients with CKD, focusing on practical considerations. Initially developed as glucose-lowering drugs, SGLT2 inhibitors preserve kidney function and reduce risks of cardiovascular events and mortality. Clinical benefits of SGLT2 inhibitors in CKD have been demonstrated in multiple clinical trials, yet utilization in practice remains relatively low, likely due to the complexity of labeled indications (past and present) and misconceptions about SGLT2 inhibitors as a class.

Methods: A panel of 8 US-based nephrologists convened in August 2022 to develop consensus guidance for the primary care community surrounding risk assessment as well as initiation and implementation of SGLT2 inhibitors in patients with CKD. Here, we provide an adapted version of the Kidney Disease: Improving Global Outcomes (KDIGO) heatmap and a treatment-decision algorithm.

Conclusions: We advocate SGLT2 inhibitors as co-first-line therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors, where RAAS inhibitor dose titration need not be completed before initiation of an SGLT2 inhibitor. In fact, SGLT2 inhibitor therapy may facilitate up-titration or maintenance of optimal RAAS inhibitor dosing. We describe potential strategies to aid implementation of an SGLT2 inhibitor in clinical practice, including improving education and awareness among care providers and patients and dispelling misconceptions about the safety of SGLT2 inhibitors. In summary, we support the use of SGLT2 inhibitors with RAAS inhibitors as co-first-line therapy in most patients with CKD.

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来源期刊
CiteScore
4.80
自引率
2.80%
发文量
183
审稿时长
15 weeks
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