如何个体化治疗慢性肾病肥胖患者的肾脏保护:ERA糖尿病工作组的评论。

IF 4.8 2区 医学 Q1 TRANSPLANTATION
Enrique Morales, William P Martin, Sebastjan Bevc, Trond G Jenssen, Marius Miglinas, Matias Trillini
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引用次数: 0

摘要

肥胖和2型糖尿病(T2DM)的相互关联的流行正在推动慢性肾脏疾病(CKD)患病率的上升,这增加了心血管事件的风险,并可能发展为终末期肾脏疾病(ESKD)。这类患者的治疗选择在过去十年中迅速扩大,并继续发展。在此,我们主要关注胰高血糖素样肽-1受体激动剂(GLP-1RAs)及其在超重/肥胖和2型糖尿病背景下CKD管理中的作用。总结了最近KDIGO CKD指南的建议,并强调了自这些指南出版以来出现的新证据。我们回顾了支持GLP-1RAs在糖尿病和CKD患者中的作用的临床研究,包括FLOW试验,并探索其肾保护作用的潜在机制。它们在ESKD患者维持性透析和肾移植后的管理中的作用,虽然证据较少,但也进行了讨论。其他以肠道激素为基础的治疗方法,包括GLP-1/GIP双激动剂(替西肽),三重激动剂(合并胰高血糖素激动剂)和amylin类似物,以改善CKD患者的心血管和肾脏预后的潜力进行了探索。我们强调了不同于肠肾轴的新疗法的作用,包括nsMRAs。我们概述了结合RAASis、SGLT2is、基于肠促胰岛素的治疗和nsMRAs的多靶点治疗的潜力,以改善超重/肥胖和T2DM患者的心血管和肾脏预后。强调了目前CKD患者多靶点治疗的时间和顺序的未知因素。在整个综述中强调了未来的优先研究问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How to individualise renoprotective therapy in obese patients with chronic kidney disease: a commentary by the Diabesity Working Group of the ERA.

The inter-related pandemics of obesity and type 2 diabetes mellitus (T2DM) are fueling a rise in the prevalence of chronic kidney disease (CKD), which amplifies the risk of cardiovascular events and which may progress to end-stage kidney disease (ESKD). Treatment options for such patients have rapidly expanded over the past decade, and continue to evolve. Herein, we primarily focus on glucagon-like peptide-1 receptor agonists (GLP-1RAs) and their role in the management of CKD in the setting of overweight/obesity and T2DM. Recommendations from the recent KDIGO CKD guidelines are summarised, and new evidence arising since publication of these guidelines is highlighted. We review clinical studies supporting the role of GLP-1RAs in patients with diabesity and CKD, including the FLOW trial, as well as exploring potential mechanisms of their nephroprotective effects. Their role in the management of patients with ESKD on maintenance dialysis and after kidney transplantation, while less evidence-based, is also discussed. The potential for other gut hormone-based therapies including GLP-1/GIP dual agonists (tirzepatide), triple agonists (incorporating glucagon agonism), and amylin analogues to improve cardiovascular and kidney outcomes in patients with CKD is explored. We highlight the role of novel therapies distinct from the gut-kidney axis, including nsMRAs. We outline the potential for multi-target therapy incorporating RAASis, SGLT2is, incretin-based treatments and nsMRAs to improve cardiovascular and kidney outcomes in patients with overweight/obesity and T2DM. Current unknowns in the timing and sequence of multi-target therapy in patients with CKD are emphasised. Priority research questions for the future are highlighted throughout the review.

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来源期刊
Nephrology Dialysis Transplantation
Nephrology Dialysis Transplantation 医学-泌尿学与肾脏学
CiteScore
10.10
自引率
4.90%
发文量
1431
审稿时长
1.7 months
期刊介绍: Nephrology Dialysis Transplantation (ndt) is the leading nephrology journal in Europe and renowned worldwide, devoted to original clinical and laboratory research in nephrology, dialysis and transplantation. ndt is an official journal of the [ERA-EDTA](http://www.era-edta.org/) (European Renal Association-European Dialysis and Transplant Association). Published monthly, the journal provides an essential resource for researchers and clinicians throughout the world. All research articles in this journal have undergone peer review. Print ISSN: 0931-0509.
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