慢性肾脏病中糖尿病患者的管理 |KDIGO联合ADA发布会议共识

近期，KI 杂志发布了 ADA 和 KDIGO 两大权威机构联合发布的会议共识，重点关注了慢性肾脏病中糖尿病患者的管理问题，有兴趣的可以看一看。

我看了一下，可能是重点提到了几个药物，GLP-1，SGLT2i，二甲双胍，MRA，ACEI/ARB。这么一搞，也促进了新型药物的推广，更多医患认识到了这些能够对糖尿病合并慢性肾病产生获益的药物。

大家来看看有哪些内容：

ADA/KDIGO CONSENSUS STATEMENTS

All patients with type 1 diabetes (T1D) or type 2 diabetes (T2D) and CKD should be treated with a comprehensive plan, outlined and agreed by health care professionals and the patient together, to optimize nutrition, exercise, smoking cessation, and weight, upon which are layered evidence-based pharmacologic therapies aimed at preserving organ function and other therapies selected to attain intermediate targets for glycemia, blood pressure (BP), and lipids.

An ACE inhibitor (ACEi) or angiotensin II receptor blocker (ARB) is recommended for patients with T1D or T2D who have hypertension and albuminuria, titrated to the maximum antihypertensive or highest tolerated dose.

A statin is recommended for all patients with T1D or T2D and CKD, moderate intensity for primary prevention of atherosclerotic cardiovascular disease (ASCVD) or high intensity for patients with known ASCVD and some patients with multiple ASCVD risk factors.

Metformin is recommended for patients with T2D, CKD, and estimated glomerular fifiltration rate (eGFR) ≥30 ml/ min/1.73 m2 ; the dose should be reduced to 1000 mg daily in patients with eGFR 30~44 ml/min/1.73 m2 and in some patients with eGFR 45~59 ml/min/1.73 m2 who are at high risk of lactic acidosis.

A sodium–glucose cotransporter-2 inhibitor (SGLT2i) with proven kidney or cardiovascular benefifit is recommended for patients with T2D, CKD, and eGFR ≥20 ml/min/1.73 m2 . Once initiated, the SGLT2i can be continued at lower levels of eGFR.

A glucagon-like peptide 1 (GLP-1) receptor agonist with proven cardiovascular benefifit is recommended for patients with T2D and CKD who do not meet their individualized glycemic target with metformin and/or an SGLT2i or who are unable to use these drugs.

A nonsteroidal mineralocorticoid receptor antagonist (nsMRA) with proven kidney and cardiovascular benefifit is recommended for patients with T2D, eGFR ≥25 ml/min/ 1.73 m2 , normal serum potassium concentration, and albuminuria (albumin-to-creatinine ratio [ACR] ≥30 mg/g)despite maximum tolerated dose of renin-angiotensin system

(RAS) inhibitor.