Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia.
Kidney Disease in Diabetic Patients: From Pathophysiology to Pharmacological Aspects with a Focus on Therapeutic Inertia.
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DOI：
10.3390/ijms22094824
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发表时间：
2021-05-01
影响因子：
5.6
通讯作者：
Trifirò G
中科院分区：
文献类型：
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作者：
Gembillo G;Ingrasciotta Y;Crisafulli S;Luxi N;Siligato R;Santoro D;Trifirò G
糖尿病日益引起公共经济和全球健康的关注。事实上，它可能导致潜在的大血管和微血管并发症，对患者的生活质量产生负面影响。糖尿病患者经常出现糖尿病肾病（DKD），这是一种可能多年未见的严重并发症。糖尿病患者出现肾损害的平均时间约为7-10年。 DKD 的临床影响不仅对于进展为终末期肾病以及肾脏替代治疗的风险而言是危险的，而且还因为心血管事件的相关增加。早期识别 DKD 进展的危险因素对于降低发病率和死亡率具有决定性作用。 DKD 提出了与患者相关、与临床医生相关以及与系统相关的问题。所有这些问题都转化为治疗惰性，其定义为未能根据循证临床指南按时启动或强化治疗。多学科医疗保健专家可以解决治疗惰性。强化治疗的时机、向最佳治疗的过渡以及饮食策略必须由多学科团队提供，推动患者达到血糖目标并延迟或克服 DKD 相关并发症。及时的肾病学评估还可以保证在肾功能损害进展时有足够的信息在正确的时间选择正确的肾脏替代疗法。
Diabetes mellitus represents a growing concern, both for public economy and global health. In fact, it can lead to insidious macrovascular and microvascular complications, impacting negatively on patients’ quality of life. Diabetic patients often present diabetic kidney disease (DKD), a burdensome complication that can be silent for years. The average time of onset of kidney impairment in diabetic patients is about 7–10 years. The clinical impact of DKD is dangerous not only for the risk of progression to end-stage renal disease and therefore to renal replacement therapies, but also because of the associated increase in cardiovascular events. An early recognition of risk factors for DKD progression can be decisive in decreasing morbidity and mortality. DKD presents patient-related, clinician-related, and system-related issues. All these problems are translated into therapeutic inertia, which is defined as the failure to initiate or intensify therapy on time according to evidence-based clinical guidelines. Therapeutic inertia can be resolved by a multidisciplinary pool of healthcare experts. The timing of intensification of treatment, the transition to the best therapy, and dietetic strategies must be provided by a multidisciplinary team, driving the patients to the glycemic target and delaying or overcoming DKD-related complications. A timely nephrological evaluation can also guarantee adequate information to choose the right renal replacement therapy at the right time in case of renal impairment progression.