Renin-angiotensin system blockers-SGLT2 inhibitorsmineralocorticoid receptor antagonists in diabetic kidney disease:A tale of the past two decades!  

作　　者：Awadhesh Kumar Singh Ritu Singh 

机构地区：[1]Department of Diabetes&Endocrinology,G.D Hospital&Diabetes Institute,Kolkata 700013,West Bengal,India

出　　处：《World Journal of Diabetes》2022年第7期471-481,共11页世界糖尿病杂志（英文版）（电子版）

摘　　要：Several pharmacological agents to prevent the progression of diabetic kidney disease(DKD)have been tested in patients with type 2 diabetes mellitus(T2DM)in the past two decades.With the exception of renin-angiotensin system blockers that have shown a significant reduction in the progression of DKD in 2001,no other pharmacological agent tested in the past two decades have shown any clinically meaningful result.Recently,the sodium-glucose cotransporter-2 inhibitor(SGLT-2i),canagliflozin,has shown a significant reduction in the composite of hard renal and cardiovascular(CV)endpoints including progression of end-stage kidney disease in patients with DKD with T2DM at the top of reninangiotensin system blocker use.Another SGLT-2i,dapagliflozin,has also shown a significant reduction in the composite of renal and CV endpoints including death in patients with chronic kidney disease(CKD),regardless of T2DM status.Similar positive findings on renal outcomes were recently reported as a top-line result of the empagliflozin trial in patients with CKD regardless of T2DM.However,the full results of this trial have not yet been published.While the use of older steroidal mineralocorticoid receptor antagonists(MRAs)such as spironolactone in DKD is associated with a significant reduction in albuminuria outcomes,a novel non-steroidal MRA finerenone has additionally shown a significant reduction in the composite of hard renal and CV endpoints in patients with DKD and T2DM,with reasonably acceptable side effects.

关 键 词：Renin-angiotensin system blockers SGLT-2 inhibitors Mineralocorticoid receptor antagonist Diabetic kidney disease Chronic kidney disease Renal outcomes Cardiovascular outcomes 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]