Type 2 diabetes mellitus and chronic kidney disease: modern opportunities for antihyperglycemic therapy
Diabetes mellitus (DM) is one of the leading causes of chronic kidney disease (CKD). It is important that besides the increased morbidity of type 2 DM, the frequency of diabetic nephropathies increased too. According to the world data, more than 80 % of CKD terminal cases are caused by DM, hypertension, or comorbidity. The most effective strategy to decrease the influence of diabetic nephropathy is the prevention of type 2 DM, as well as diagnosis and treatment of CKD in early stages among those who are already suffering from diabetes. Compensation of carbohydrate metabolism and the control of blood pressure play the leading role in decreasing the risk of diabetic kidney disease or slowing its progression. But on advanced stages of CKD, the compensation of carbohydrate metabolism is complicated due to the high risk of hypoglycemia. The article reviews the publications and guidelines on the safety and opportunities for use of hypoglycemic agents in patients with type 2 DM and CKD. Drugs with proved cardioprotective and nephroprotective properties, namely sodium-glucose transporter protein 2 inhibitors, are not used at glomerular filtration rate (GFR) < 45 ml/min/1.73 m2, and glucagon-like peptide-1 receptor agonists — at GFR < 30 ml/min/1.73 m2. Incretin mimetics had proven themselves as drugs for metabolism control in the comprehensive therapy of patients with type 2 DM, including those with CKD. Published data show the efficacy and safety of dipeptidyl peptidase-4 inhibitors used nowadays in patients with decreased GFR (including people on dialysis). Special attention is paid to vildagliptin, a selective oral dipeptidyl peptidase-4 inhibitor, which due to its favorable safety profile is used successfully in elderly patients with type 2 DM and CKD, as well as with a history of severe cardiovascular pathology, at all stages of CKD (including uremia), in patients with high hypoglycemia risk. Target glycemic levels in patients with type DM and CKD have to be individualized considering life expectancy, renal function, risk of hypoglycemia, and comorbid pathology.
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World Health Organisation (WHO). Diabetes: Key facts. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes. Accessed: May 15, 2020.
Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. doi:10.1016/j.diabres.2019.107843.
Zhang XX, Kong J, Yun K. Prevalence of Diabetic Nephropathy among Patients with Type 2 Diabetes Mellitus in China: A Meta-Analysis of Observational Studies. J Diabetes Res. 2020;2020:2315607. doi:10.1155/2020/2315607.
Zhang N, Gao ZN. Prevalence and risk factor analysis of early diabetic nephropathy in patients with type 2 diabetes mellitus. Journal of aerospace medicine. 2016;27:1473-1476.
Craig ME, Hattersley A, Donaghue KC. Definition, epidemiology and classification of diabetes in children and adolescents. Pediatr Diabetes. 2009;10 Suppl 12:3‐12. doi:10.1111/j.1399-5448.2009.00568.x.
Komenda P, Ferguson TW, Macdonald K, Rigatto C, Koolage C, Sood MM, et al. Cost-effectiveness of primary screening for CKD: a systematic review. Am J Kidney Dis. 2014;63(5):789–97; DOI:10.1053/j.ajkd.2013.12.012.
Didushko OM, Herych PR, Cherniavska IV, Yatsyshyn RI, Pankiv VI. Influence of the complex treatment of hypothyroidism on the leptin level in patients with primary hypothyroidism. World of Medicine and Biology. 2018;(65):59-63. doi:10.26724/2079-8334-2018-3-65-59-63.
National Kidney Foundation (NKF). Glomerular filtration rate (GFR) Calculator. Available from: https://www.kidney.org/professionals/kdoqi/gfr_calculator.
Matsushita K, Tonelli M, Lloyd A, et al. Clinical risk implications of the CKD Epidemiology Collaboration (CKD-EPI) equation compared with the Modification of Diet in Renal Disease (MDRD) Study equation for estimated GFR. Am J Kidney Dis. 2012;60(2):241‐249. doi:10.1053/j.ajkd.2012.03.016.
Kidney Disease: Improving Global Outcomes (KDIGO). KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney International Supplements. 2013;3(1):1-150.
National Kidney Foundation (NKF). Global Facts: About Kidney Disease. Available from: https://www.kidney.org/kidneydisease/global-facts-about-kidney-disease. Accessed: March, 2015.
National Institute for Health and Care Exellence (NICE). Chronic kidney disease in adults: assessment and management (CG182). Chronic kidney disease in adults: assessment and management. London: National Institute for Health and Care Excellence; 2015. 63 p.
Lee YL, Yen SJ, Shin SJ, Huang YC, He JS, Lin KD. Severe Hypoglycemia as a Predictor of End-Stage Renal Disease in Type 2 Diabetes: A National Cohort Study. Int J Environ Res Public Health. 2019;16(5):681. Published 2019 Feb 26. doi:10.3390/ijerph16050681.
Morgunov LYu. Hypoglycemia and possibilities of oral therapy of type 2 diabetes in patients with chronic kidney disease. Endokrinologiia: novosti, mneniia, obuchenie. 2018;7(4):23-31. doi:10.24411/2304-9529-2018-14003. (in Russian).
Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255‐323. doi:10.1093/eurheartj/ehz486.
Carretero Gómez J, Arévalo Lorido JC. Clinical assessment and treatment of diabetes in patients with chronic kidney disease. Evaluación clínica y tratamiento de la diabetes en pacientes con enfermedad renal crónica. Rev Clin Esp. 2018;218(6):305‐315. doi:10.1016/j.rce.2018.03.016.
Pugliese G, Penno G, Natali A, et al. Diabetic kidney disease: new clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on "The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function". J Nephrol. 2020;33(1):9‐35. doi:10.1007/s40620-019-00650-x.
Trubitsyna NP, Severina AS, Shamkhalova MSh, Shestakova MV. Novel approaches of glucose-lowering therapy in type 2 diabetes and chronic kidney disease. Problemi Endocrinologii. 2015;61(6):36-43. doi:10.14341/probl201561636-43. (in Russian).
Muskiet MH, Smits MM, Morsink LM, Diamant M. The gut-renal axis: do incretin-based agents confer renoprotection in diabetes? [published correction appears in Nat Rev Nephrol. 2014 Jul;10(7):362]. Nat Rev Nephrol. 2014;10(2):88‐103. doi:10.1038/nrneph.2013.272.
Perl S, Cook W, Wei C, Iqbal N, Hirshberg B. Saxagliptin Efficacy and Safety in Patients With Type 2 Diabetes and Moderate Renal Impairment. Diabetes Ther. 2016;7(3):527‐535. doi:10.1007/s13300-016-0184-9.
Rosenstock J, Perkovic V, Johansen OE, et al. Effect of Linagliptin vs Placebo on Major Cardiovascular Events in Adults With Type 2 Diabetes and High Cardiovascular and Renal Risk: The CARMELINA Randomized Clinical Trial. JAMA. 2019;321(1):69‐79. doi:10.1001/jama.2018.18269.
Kothny W, Lukashevich V, Foley JE, Rendell MS, Schweizer A. Comparison of vildagliptin and sitagliptin in patients with type 2 diabetes and severe renal impairment: a randomised clinical trial. Diabetologia. 2015;58(9):2020‐2026. doi:10.1007/s00125-015-3655-z.
Ito M, Abe M, Okada K, et al. The dipeptidyl peptidase-4 (DPP-4) inhibitor vildagliptin improves glycemic control in type 2 diabetic patients undergoing hemodialysis. Endocr J. 2011;58(11):979‐987. doi:10.1507/endocrj.ej11-0025.
Ito H, Mifune M, Matsuyama E, et al. Vildagliptin is effective for glycemic control in diabetic patients undergoing either hemodialysis or peritoneal dialysis. Diabetes Ther. 2013;4(2):321‐329. doi:10.1007/s13300-013-0029-8.
Betônico CC, Titan SM, Correa-Giannella ML, Nery M, Queiroz M. Management of diabetes mellitus in individuals with chronic kidney disease: therapeutic perspectives and glycemic control. Clinics (Sao Paulo). 2016;71(1):47‐53. doi:10.6061/clinics/2016(01)08.
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