Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: A review of pathophysiology, mechanisms, and evidence from recent trials.
Improving the residual risk of renal and cardiovascular outcomes in diabetic kidney disease: A review of pathophysiology, mechanisms, and evidence from recent trials.
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DOI：
10.1111/dom.14601
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发表时间：
2022-03
影响因子：
5.8
通讯作者：
Arora, Pradeep
中科院分区：
文献类型：
--
作者：
Chaudhuri, Ajay;Ghanim, Husam;Arora, Pradeep
关键词：
根据全球估计，近10%的成年人患有糖尿病，其中40%估计还患有慢性肾脏疾病（CKD）。大约20年前，针对肾素-血管紧张素系统（RAS）的治疗被证明可以减缓肾脏疾病的进展。最近，研究报道了抗高血糖钠-葡萄糖共转运体- 2抑制剂与RAS抑制剂联合使用对CKD进展和心血管结局的附加益处。然而，这些最近的数据也显示，患者继续发展为肾衰竭或死于肾脏或心血管相关原因。因此，需要新的药物来解决这一持续的风险。矿盐皮质激素（MR）受体的过度激活有助于肾脏炎症和纤维化，这表明它是糖尿病和CKD患者的合适治疗靶点。新的选择性非甾体MR拮抗剂正在这些患者中进行研究，最近完成的两项大型临床试验的结果表明，与标准治疗相比，其中一种治疗方法，细芬烯酮，显著减少CKD进展和心血管事件。本文综述了2型糖尿病CKD的发病机制，并探讨了针对这些患者的炎症和纤维化因子的新型疾病修饰药物的潜在益处。
Based on global estimates, almost 10% of adults have diabetes, of whom 40% are estimated to also have chronic kidney disease (CKD). Almost 2 decades ago, treatments targeting the renin‐angiotensin system (RAS) were shown to slow the progression of kidney disease. More recently, studies have reported the additive benefits of antihyperglycaemic sodium‐glucose co‐transporter‐2 inhibitors in combination with RAS inhibitors on both CKD progression and cardiovascular outcomes. However, these recent data also showed that patients continue to progress to kidney failure or die from kidney‐ or cardiovascular‐related causes. Therefore, new agents are needed to address this continuing risk. Overactivation of the mineralocorticoid (MR) receptor contributes to kidney inflammation and fibrosis, suggesting that it is an appropriate treatment target in patients with diabetes and CKD. Novel, selective non‐steroidal MR antagonists are being studied in these patients, and the results of two large recently completed clinical trials have shown that one such treatment, finerenone, significantly reduces CKD progression and cardiovascular events compared with standard of care. This review summarizes the pathogenic mechanisms of CKD in type 2 diabetes and examines the potential benefit of novel disease‐modifying agents that target inflammatory and fibrotic factors in these patients.
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影响因子：
4.2
作者：
Garcia-Garcia, Patricia M.;Getino-Melian, Maria A.;Navarro-Gonzalez, Juan F.
通讯作者：
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影响因子：
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作者：
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影响因子：
158.5
作者：
Bakris, George L.;Agarwal, Rajiv;Filippatos, Gerasimos
通讯作者：
Filippatos, Gerasimos
影响因子：
39.3
作者：
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通讯作者：
Pitt B