盐皮质激素受体拮抗剂在糖尿病肾病中的作用

M. Alexandrou, Marieta P. Theodorakopoulou, P. Sarafidis
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引用次数: 3

摘要

糖尿病肾病(DKD)是一个主要的公共卫生问题,目前对医疗系统构成了重要负担。肾素-血管紧张素系统(RAS)阻断剂被认为是治疗白蛋白尿型DKD的基石。然而,RAS阻断下进展为更晚期CKD的高残余风险仍然存在,而相关研究并未显示这些药物在DKD患者中的心血管事件显著下降。在其他几类药理学中,盐皮质激素受体拮抗剂(MRAs)受到了越来越多的关注,因为越来越多的高质量证据表明,螺内酯和依普利酮可以显著降低CKD患者的血压和蛋白尿。此外,finereone是一种具有独特理化性质的新型非甾体MRA,被证明可以有效降低2型糖尿病患者的心血管事件和死亡,以及终末期肾病的发病率。这篇综述讨论了盐皮质激素受体拮抗作用对DKD的肾脏保护和心脏保护问题的先前和最近的临床证据,旨在帮助临床医生做出糖尿病患者的治疗决定。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease
Diabetic kidney disease (DKD) represents a major public health issue, currently posing an important burden on healthcare systems. Renin–angiotensin system (RAS) blockers are considered the cornerstone of treatment of albuminuric DKD. However, a high residual risk of progression to more advanced CKD stages under RAS blockade still remains, while relevant studies did not show significant declines in cardiovascular events with these agents in patients with DKD. Among several other pharmacological classes, mineralocorticoid receptor antagonists (MRAs) have received increasing interest, due to a growing body of high-quality evidence showing that spironolactone and eplerenone can significantly lower blood pressure and albuminuria in patients with CKD. Furthermore, finerenone, a novel nonsteroidal MRA with unique physicochemical properties, was shown to effectively reduce cardiovascular events and death, as well as the incidence of end-stage kidney disease in patients with type 2 diabetes. This review discusses previous and recent clinical evidence on the issue of nephroprotection and cardioprotection in DKD offered by mineralocorticoid receptor antagonism, aiming to aid clinicians in their treatment decisions for diabetic patients.
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