Procena renoprotektivne efikasnosti terapije inhibitorima natrijum-glukoznog kotransportera tipa 2 kod bolesnika sa hroničnom bolešću bubrega: prospektivna studija

  • Vidna Karadžić Ristanović University Clinical Center of Serbia, Clinic for Nephrology, Belgrade, Serbia
  • Selena Gajić University Clinical Center of Serbia, Clinic for Nephrology, Belgrade, Serbia
  • Ana Bontić University Clinical Center of Serbia, Clinic for Nephrology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Jelena Pavlović University Clinical Center of Serbia, Clinic for Nephrology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Aleksandra Kezić University Clinical Center of Serbia, Clinic for Nephrology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Jovana Radovanović University of Kragujevac, Faculty of Medical Sciences, Kragujevac, Serbia
  • Milan Radović University Clinical Center of Serbia, Clinic for Nephrology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP230805061K
Ključne reči: lečenje lekovima, proteinurija, bubreg, hronična insuficijencija, natrijum-glukozni transporter 2, inhibitori, lečenje, ishod

Sažetak


 

Uvod/Cilj. Hronična bolest bubrega (HBB) predstavlja globalni zdravstveni problem, povezan sa povećanim kardiovaskularnim rizicima i preranom smrtnošću. Proteinurija je ključni prognostički pokazatelj ishoda HBB. Inhibitori natrijum-glukoznog kotransportera tipa 2 (NGKT2) pokazuju potencijal za smanjivanje proteinurije i usporavanje progresije HBB. Cilj rada bio je da se utvrdi uticaj terapije inhibitorima NGKT2 na bolesnike sa HBB procenom promene u nivou serumskog kreatinina (sKr), 24-časovne (24h) proteinurije (PU), brzine glomerularne filtracije (glomerular filtration rate – GFR) i krvnog pritiska (KP). Metode. U prospektivnu studiju bilo je uključeno 79 bolesnika sa HBB, praćenih tokom godinu dana. Bolesnici su primali inhibitor NGKT2 (dapagliflozin) jednom dnevno (10 mg), a merenja određenih  parametara sprovedena su na početku terapije, šest meseci kasnije i godinu dana posle početka terapije. Studijom su procenjivane vrednosti sKr, 24h PU, GFR, sistolnog KP (KPs), dijastolnog KP (KPd), mokraćne kiseline (MK), ukupnog holesterola (UH), triglicerida (Tg), holesterola niske gustine (low density lipoprotein – LDL), natrijuma (Na+) i kalijuma (K+). Rezultati. Tokom godinu dana praćenja, pokazane su značajne promene u nivoima MK (5,36, 4,99, 4,94 mg/dL, redom; p = 0,032), 24h PU (662,60, 574,11, 417,09 mg/dL, redom; p = 0,028), kao i KPs (128,44, 125,64, 126,12 mmHg, redom; p = 0,026). Nisu zapažene značajne varijacije u vrednostima za GFR, KPd, sKr,

UH, Tg, LDL i K+. Nivo Na+ pokazao je primetno smanjenje (148,21, 147,57, 146,41 mmol/L, redom; p = 0,021). Zaključak. Studija ukazuje na postojanje potencijalne koristi od inhibitora NGKT2 u lečenju bolesnika sa HBB.

Reference

Borg R, Carlson N, Søndergaard J, Persson F. The Growing Chal-lenge of Chronic Kidney Disease: An Overview of Current Knowledge. Int J Nephrol 2023; 2023: 9609266.

Georgianos PI, Agarwal R. Hypertension in chronic kidney dis-ease - treatment standard 2023. Nephrol Dial Transplant 2023; gfad118.

Elendu C, Elendu RC, Enyong JM, Ibhiedu JO, Ishola IV, Egbunu EO, et al. Comprehensive review of current management guidelines of chronic kidney disease. Medicine (Baltimore) 2023; 102(23): e33984.

Liu W, Zhou L, Yin W, Wang J, Zuo X. Global, regional, and national burden of chronic kidney disease attributable to high sodium intake from 1990 to 2019. Front Nutr 2023; 10: 1078371.

Kataoka H, Mochizuki T, Ohara M, Tsuruta Y, Iwasa N, Yoshida R, et al. Urate-lowering therapy for CKD patients with asymptomatic hyperuricemia without proteinuria elucidated by attribute-based research in the FEATHER Study. Sci Rep 2022; 12(1): 3784.

Lafayette RA, Canetta PA, Rovin BH, Appel GB, Novak J, Nath KA, et al. A Randomized, Controlled Trial of Rituximab in IgA Nephropathy with Proteinuria and Renal Dysfunction. J Am Soc Nephrol 2017; 28(4): 1306–13.

Provenzano M, Puchades MJ, Garofalo C, Jongs N, D'Marco L, An-dreucci M, et al. Albuminuria-Lowering Effect of Dapagliflozin, Eplerenone, and Their Combination in Patients with Chronic Kidney Disease: A Randomized Crossover Clinical Trial. J Am Soc Nephrol 2022; 33(8): 1569–80.

Swartling O, Rydell H, Stendahl M, Segelmark M, Trolle Lagerros Y, Evans M. CKD Progression and Mortality Among Men and Women: A Nationwide Study in Sweden. Am J Kidney Dis 2021; 78(2): 190–9.e1.

Heerspink HJL, Karasik A, Thuresson M, Melzer-Cohen C, Chodick G, Khunti K, et al. Kidney outcomes associated with use of SGLT2 inhibitors in real-world clinical practice (CVD-REAL 3): a multinational observational cohort study. Lancet Diabetes Endocrinol 2020; 8(1): 27–35.

Kalay Z, Sahin OE, Copur S, Danacı S, Ortiz A, Yau K, et al. SGLT-2 inhibitors in nephrotic-range proteinuria: emerging clinical evidence. Clin Kidney J 2022; 16(1): 52–60.

Lingli X, Qing Z, Wenfang X. Diagnostic value of the modifica-tion of Diet in Renal Disease and Chronic Kidney Disease Ep-idemiology Collaboration equations in diabetic patients: a sys-tematic review and meta-analysis. J Int Med Res 2020; 48(6): 300060520925950.

Kao HY, Chang CC, Chang CF, Chen YC, Cheewakriangkrai C, Tu YL. Associations between Sex and Risk Factors for Predicting Chronic Kidney Disease. Int J Environ Res Public Health 2022; 19(3): 1219.

Lewandowski MJ, Krenn S, Kurnikowski A, Bretschneider P, Sattler M, Schwaiger E, et al. Chronic kidney disease is more prevalent among women but more men than women are under nephro-logical care: Analysis from six outpatient clinics in Austria 2019. Wien Klin Wochenschr 2023; 135(3–4): 89–96.

Liu P, Quinn RR, Lam NN, Al-Wahsh H, Sood MM, Tangri N, et al. Progression and Regression of Chronic Kidney Disease by Age Among Adults in a Population-Based Cohort in Alberta, Canada. JAMA Netw Open 2021; 4(6): e2112828.

Kerklaan J, Hannan E, Hanson C, Guha C, Cho Y, Christian M, et al. Perspectives on life participation by young adults with Chronic kidney disease: an interview study. BMJ Open 2020; 10(10): e037840.

Mallappallil M, Friedman EA, Delano BG, McFarlane SI, Salifu MO. Chronic kidney disease in the elderly: evaluation and management. Clin Pract (Lond) 2014; 11(5): 525–35.

Ferris ME, Miles JA, Seamon ML. Adolescents and Young Adults with Chronic or End-Stage Kidney Disease. Blood Pu-rif 2016; 41(1–3): 205–10.

Wetmore JB, Guo H, Liu J, Collins AJ, Gilbertson DT. The inci-dence, prevalence, and outcomes of glomerulonephritis de-rived from a large retrospective analysis. Kidney Int 2016; 90(4): 853–60.

Meremo AJ, Masalu MB, Sabi I, Ngilangwa DP, Kapinga J, Tagalile R, et al. Prevalence and Risk Factors Associated With Chronic Kidney Disease Among Patients Presenting at a Haemodialysis Unit in Dodoma, Tanzania. East Afr Health Res J 2018; 2(1): 53–7.

Gupta A, Nagaraju SP, Bhojaraja MV, Swaminathan SM, Mohan PB. Hypertension in Chronic Kidney Disease: An Update on Diagnosis and Management. South Med J 2023; 116(2): 237–44.

Hamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Adv Exp Med Biol 2017; 956: 307–25.

Żyłka A, Gala-Błądzińska A, Rybak K, Dumnicka P, Drożdż R, Kuśnierz-Cabala B. Role of new biomarkers for the diagnosis of nephropathy associated with diabetes type 2. Folia Med Cracov 2015; 55(4): 21–33.

Lee WC, Lee YT, Li LC, Ng HY, Kuo WH, Lin PT, et al. The Number of Comorbidities Predicts Renal Outcomes in Pa-tients with Stage 3⁻5 Chronic Kidney Disease. J Clin Med 2018; 7(12): 493.

MacRae C, Mercer SW, Guthrie B, Henderson D. Comorbidity in chronic kidney disease: a large cross-sectional study of preva-lence in Scottish primary care. Br J Gen Pract 2021; 71(704): e243–9.

Briasoulis A, Al Dhaybi O, Bakris GL. SGLT2 Inhibitors and Mechanisms of Hypertension. Curr Cardiol Rep 2018; 20(1): 1.

Baker WL, Smyth LR, Riche DM, Bourret EM, Chamberlin KW, White WB. Effects of sodium-glucose co-transporter 2 inhibi-tors on blood pressure: a systematic review and meta-analysis. J Am Soc Hypertens 2014; 8(4): 262–75.e9.

Chu C, Lu YP, Yin L, Hocher B. The SGLT2 Inhibitor Empagliflozin Might Be a New Approach for the Prevention of Acute Kidney Injury. Kidney Blood Press Res 2019; 44(2): 149–57.

Yau K, Dharia A, Alrowiyti I, Cherney DZI. Prescribing SGLT2 Inhibitors in Patients with CKD: Expanding Indications and Practical Considerations. Kidney Int Rep 2022; 7(7): 1463–76.

Takashima H, Yoshida Y, Nagura C, Furukawa T, Tei R, Maruya-ma T, et al. Renoprotective effects of canagliflozin, a sodium glucose cotransporter 2 inhibitor, in type 2 diabetes patients with chronic kidney disease: A randomized open-label pro-spective trial. Diab Vasc Dis Res 2018; 15(5): 469–72.

Petrykiv S, Sjöström CD, Greasley PJ, Xu J, Persson F, Heerspink HJL. Differential Effects of Dapagliflozin on Cardiovascular Risk Factors at Varying Degrees of Renal Function. Clin J Am Soc Nephrol 2017; 12(5): 751–9.

Murashima R, Sai E, Tagawa Y, Yanagawa H, Ishiwata S, Kawagu-chi Y, et al. Usefulness of Dapagliflozin for Nephrotic Syn-drome Secondary to Diabetic Kidney Disease. Intern Med 2022; 61(24): 3699–702.

Tanaka A, Nakamura T, Sato E, Node K. Therapeutic potential of tofogliflozin on nephrotic syndrome secondary to diabetic nephropathy. J Cardiol Cases 2017; 16(1): 30–3.

Bailey CJ, Day C, Bellary S. Renal Protection with SGLT2 Inhibitors: Effects in Acute and Chronic Kidney Disease. Curr Diab Rep 2022; 22(1): 39–52.

Banerjee M, Pal R, Maisnam I, Chowdhury S, Mukhopadhyay S. Se-rum uric acid lowering and effects of sodium-glucose cotrans-porter-2 inhibitors on gout: A meta-analysis and meta-regression of randomized controlled trials. Diabetes Obes Metab 2023; 25(9): 2697–703.

Tang H, Cui W, Li D, Wang T, Zhang J, Zhai S, et al. Sodium-glucose co-transporter 2 inhibitors in addition to insulin thera-py for management of type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. Diabetes Obes Metab 2017; 19(1): 142–7.

Perkovic V, Jardine MJ, Neal B, Bompoint S, Heerspink HJL, Charytan DM, et al. Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. N Engl J Med 2019; 380(24): 2295–306.

Heerspink HJL, Stefánsson BV, Correa-Rotter R, Chertow GM, Greene T, Hou FF, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2020; 383(15): 1436–46.

The EMPA-KIDNEY Collaborative Group; Herrington WG, Staplin N, Wanner C, Green JB, Hauske SJ, et al. Empagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2023; 388(2): 117–27.

Objavljeno
2024/01/30
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Vol. 81 Br. 01 (2024): Vojnosanitetski pregled
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Originalni članak