CHRONIC KIDNEY DISEASE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CLINICAL AND PROGNOSTIC ANALYSIS OF PROGRESSION FACTORS AND THE EFFECTIVENESS OF NEPHROPROTECTIVE THERAPY
Keywords:
Chronic kidney disease, type 2 diabetes mellitus, diabetic nephropathyAbstract
Chronic kidney disease (CKD) is one of the most significant complications of type 2 diabetes mellitus (T2DM) and substantially increases the risk of cardiovascular mortality. Diabetic nephropathy develops in the setting of prolonged hyperglycemia, systemic inflammation, and activation of the renin–angiotensin–aldosterone system. Early diagnosis and comprehensive nephroprotective therapy can slow the decline in glomerular filtration rate and reduce the risk of end-stage renal disease. This study is devoted to evaluating the factors associated with CKD progression in patients with T2DM and analyzing the effectiveness of combined therapy. The study included 186 patients who were followed for 36 months. The obtained data indicate a statistically significant slowing of renal function decline with the use of renin–angiotensin system inhibitors in combination with modern glucose-lowering agents.
References
1. American Diabetes Association. Standards of Medical Care in Diabetes — 2023 // Diabetes Care. 2023. Vol. 46(Suppl.1). P. S1–S291. DOI: 10.2337/dc23-SINT
2. Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease // Kidney International. 2022. Vol. 102(4S). P. S1–S127. DOI: 10.1016/j.kint.2022.06.008
3. Brenner B.M., Cooper M.E., de Zeeuw D. et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes // New England Journal of Medicine. 2001. Vol. 345. P. 861–869. DOI: 10.1056/NEJMoa011161
4. Lewis E.J., Hunsicker L.G., Clarke W.R. et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes // New England Journal of Medicine. 2001. Vol. 345. P. 851–860. DOI: 10.1056/NEJMoa011303
5. Perkovic V., Jardine M.J., Neal B. et al. Canagliflozin and renal outcomes in type 2 diabetes and nephropathy // New England Journal of Medicine. 2019. Vol. 380. P. 2295–2306. DOI: 10.1056/NEJMoa1811744
6. Heerspink H.J.L., Stefansson B.V., Correa-Rotter R. et al. Dapagliflozin in patients with chronic kidney disease // New England Journal of Medicine. 2020. Vol. 383. P. 1436–1446. DOI: 10.1056/NEJMoa2024816
7. Wanner C., Inzucchi S.E., Lachin J.M. et al. Empagliflozin and progression of kidney disease in type 2 diabetes // New England Journal of Medicine. 2016. Vol. 375. P. 323–334. DOI: 10.1056/NEJMoa1515920
8. Bakris G.L., Agarwal R., Anker S.D. et al. Finerenone in patients with chronic kidney disease and type 2 diabetes // New England Journal of Medicine. 2020. Vol. 383. P. 2219–2229. DOI: 10.1056/NEJMoa2025845
9. Tuttle K.R., Bakris G.L., Bilous R.W. et al. Diabetic kidney disease: a report from an ADA Consensus Conference // Diabetes Care. 2014. Vol. 37(10). P. 2864–2883. DOI: 10.2337/dc14-1296
10. Thomas M.C., Brownlee M., Susztak K. et al. Diabetic kidney disease // Nature Reviews Disease Primers. 2015. Vol. 1. Article 15018. DOI: 10.1038/nrdp.2015.18
