Jaunās hroniskas nieru slimības terapijas iespējas
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Ievads. Hroniska nieru slimība (HNS) ir plaši izplatīta sabiedrības veselības problēma, kura ietekmē pacientu dzīves kvalitāti un ievērojami palielina mirstību. Pēdējos 20 gadus hroniskas nieru slimības progresēšanas aizkavēšanai lietoja AKEI (angiotenzīnu konvertējošā enzīma inhibitori) un ARB (Angiotenzīna II receptora blokatori), tomēr ieguvums bija relatīvi limitēts pacientiem ar HNS bez 2.tipa cukura diabēta. Jaunākās medikamentu grupas, kuru ilgstoša lietošana labvēlīgi ietekmē hroniskas nieru slimības progresēšanas aizkavēšanu, ir SGLT-2 inhibitori un nesteroīdālie MRA, kā arī GLP-1 agonisti.
Pētnieciskā darba mērķis. Noskaidrot un aprakstīt hroniskas nieru slimības jaunās terapijas iespējas un izvērtēt jauno medikamentu grupu pielietošanas ieguvumu.
Metodoloģija. Zinātniskās literatūras apskats atbilstoši darba tēmai, izmantojot uz pierādījumiem balstītām medicīnas datubāzes.
Secinājumi. Pateicoties jauniem medikamentiem var sasniegt gan nefroprotektīvus, gan kardiovaskulārus ieguvumus, kas tieši ietekmē mirstības radītājus HNS pacientu gadījumā. Tie nodrošina vairāku HNS patoģenētisku un simptomātisku faktoru likvidēšanu. Patoģenētiski jauno grupu medikamentiem piemīt gan pretiekaisuma, gan antifibrotiski, gan intraglomerulārā spiediena mazinoši efekti.
SGLT-2 inhibitori un GLP-1 agonisti samazina paaugstinātu glikozes līmeni asinīs, kas ir viens no galvenajiem HNS cēloņiem, kā arī palīdz normalizēt svaru. SGLT-2 inhibitoru atsevišķa lietošana parādīja savu efektivitāti HNS progresēšanas aizkavēšanā gan nediabētiskajiem pacientiem, gan pacientiem ar 2. tipa cukura diabētu.
Nesteroīdālo MRA grupas medikamentu lietošana dod ieguvumu HNS progresēšanas aizkavēšanā pateicoties antifibrotiskai un pretiekaisuma iedarbībai.
SGLT-2 inhibitoru un nesteroīdālo MRA kombinācijas lietošanai ir labvēlīgāks efekts uz hiperkaliēmijas attīstības riska samazināšanu, salīdzinot ar finerenona (nesteroīdālo MRA grupas medikaments) atsevišķu lietošanu. SGLT-2 inhibitoru un GLP-1 agonistu kombinācijas labvēlīgi efekti — albuminūrijas samazināšana, svara normalizēšanas un asinsspiediena pazemināšanas potenciāli var palīdzēt aizkavēt HNS progresēšanas gaitu.
Objectives. Chronic kidney disease (CKD) is a widespread public health problem, that affects patients quality of life and significantly increases mortality. ACEIs (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) have been used to delay the progression of the chronic kidney disease for the past 20 years, but the benefits have been relatively limited in patients with CKD without type 2 diabetes. The newest classes of drugs, which long-term use had a beneficial effect on delaying the progression of CDK, are SGLT-2 inhibitors and non-steroidal MRAs, as well as GLP-1 agonists. The aim of the research work. To find out and describe the novel treatment options for chronic kidney disease and to evaluate the benefits of using new groups of drugs. Materials and Methods. Review of scientific literature according to the topic of the work, using evidence-based medical databases. Conclusions. Thanks to novel drugs, both nephroprotective and cardiovascular benefits can be achieved, which have a direct impact on mortality in CKD patients. They eliminate a number of pathogenic and symptomatic factors in CKD. Pathogenically new drugs have anti-inflammatory, anti-fibrotic and intraglomerular antihypertensive effects. SGLT-2 inhibitors and GLP-1 agonists reduce high glucose level in blood, which is one of the main causes of CKD, and help to normalise weight. The use of SGLT-2 inhibitors alone has been shown to be effective in delaying the progression of CKD in both non-diabetic patients and patients with type 2 diabetes. The use of non-steroidal MRAs has been shown to delay the progression of CKD due to its antifibrotic and anti-inflammatory effects. The combination of SGLT-2 inhibitors and non-steroidal MRAs has a more beneficial effect in reducing the risk of developing hyperkalaemia compared to finerenone alone (a non-steroidal MRAs drug). The beneficial effects of the combination of SGLT-2 inhibitors and GLP-1 agonists - the reduction of albuminuria, the normalisation of weight and the potential to lower blood pressure - may help to delay the progression of HNS.
Objectives. Chronic kidney disease (CKD) is a widespread public health problem, that affects patients quality of life and significantly increases mortality. ACEIs (angiotensin converting enzyme inhibitors) and ARBs (angiotensin II receptor blockers) have been used to delay the progression of the chronic kidney disease for the past 20 years, but the benefits have been relatively limited in patients with CKD without type 2 diabetes. The newest classes of drugs, which long-term use had a beneficial effect on delaying the progression of CDK, are SGLT-2 inhibitors and non-steroidal MRAs, as well as GLP-1 agonists. The aim of the research work. To find out and describe the novel treatment options for chronic kidney disease and to evaluate the benefits of using new groups of drugs. Materials and Methods. Review of scientific literature according to the topic of the work, using evidence-based medical databases. Conclusions. Thanks to novel drugs, both nephroprotective and cardiovascular benefits can be achieved, which have a direct impact on mortality in CKD patients. They eliminate a number of pathogenic and symptomatic factors in CKD. Pathogenically new drugs have anti-inflammatory, anti-fibrotic and intraglomerular antihypertensive effects. SGLT-2 inhibitors and GLP-1 agonists reduce high glucose level in blood, which is one of the main causes of CKD, and help to normalise weight. The use of SGLT-2 inhibitors alone has been shown to be effective in delaying the progression of CKD in both non-diabetic patients and patients with type 2 diabetes. The use of non-steroidal MRAs has been shown to delay the progression of CKD due to its antifibrotic and anti-inflammatory effects. The combination of SGLT-2 inhibitors and non-steroidal MRAs has a more beneficial effect in reducing the risk of developing hyperkalaemia compared to finerenone alone (a non-steroidal MRAs drug). The beneficial effects of the combination of SGLT-2 inhibitors and GLP-1 agonists - the reduction of albuminuria, the normalisation of weight and the potential to lower blood pressure - may help to delay the progression of HNS.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Hroniska nieru slimība, nātrija glikozes kotransportiera-2 (SGLT-2) inhibitori, nesteroīdālie minerālkortikoīdu receptoru antagonisti (MRA), glukagonam līdzīgā peptīda-1 receptora (GLP-1) agonisti, Chronic kidney disease, sodium-glucose cotransporter-2 (SGLT-2) inhibitors; non-steroidal mineralcorticoid receptor antagonists (MRAs), glucagon-like peptide-1 (GLP-1) agonists