Diabetic chronic kidney disease treatment philosophy update: seven important recommendations

[Update on the treatment concept of diabetic chronic kidney disease: seven important suggestions] Diabetes is afraid of proteinuria, and kidney patients are afraid of high blood sugar. Diabetes is like falling into a swamp when it encounters kidney disease. If it is not treated in time, it will sink deeper and deeper, and eventually be dragged into the abyss by uremia, heart failure, myocardial infarction, etc.

What should I do if diabetes encounters kidney disease?

Recently, two international authoritative organizations, the American Diabetes Association (ADA) and the Kidney Disease Improvement Global Outcomes Organization (KDIGO), jointly developed the “Diabetes Management in Chronic Kidney Disease: A Joint ADA/KDIGO Consensus Report”. , making seven key recommendations:

1. All patients with diabetes (including type 1 diabetes and type 2 diabetes) and chronic kidney disease should be managed comprehensively, including optimizing nutrition, exercise, smoking cessation and weight loss, and controlling blood sugar, blood pressure and blood lipids , Priority should be given to antihypertensive, hypoglycemic, and lipid-lowering drugs with organ protection.

2. For patients with type 1 diabetes mellitus and type 2 diabetes mellitus with hypertension and proteinuria, it is recommended to use sartans or pril antihypertensive drugs, and the dose should be gradually increased to the maximum tolerance. subject to dose.

3. It is recommended that all patients with type 1 diabetes and type 2 diabetes with chronic kidney disease should use statin lipid-lowering drugs, medium doses for primary prevention of cardiovascular disease, high doses for secondary prevention.

4. Metformin is recommended for patients with type 2 diabetes mellitus combined with chronic kidney disease and a glomerular filtration rate ≥30 mL/min. However, in patients with a glomerular filtration rate <45 mL/min, the dose of metformin should not exceed 1 g per day.

5, Type 2 diabetes mellitus patients with chronic kidney disease, and glomerular filtration rate ≥ 20mL/min, it is recommended to use the antidiabetic drugs of the class of Lysin, which have been proved to be effective in Renal or cardiovascular benefits. If you have already started using gliclazin, you can continue to use it even if the glomerular filtration rate is less than 20 mL/min.

6. For patients with type 2 diabetes mellitus and chronic kidney disease, if the use of metformin and/or lysine-type hypoglycemic agents cannot control the blood sugar level, or cannot use these drugs, it is recommended to use peptides hypoglycemic agents, which have been shown to have cardiovascular benefits.

7. In patients with type 2 diabetes, if proteinuria (ACR ≥ 30 mg/g), glomerular filtration rate ≥ 25 mL/min, serum potassium is not high, and sartans Alternatively, in patients who have been treated with maximal tolerated doses of pril, a nonsteroidal mineralocorticoid receptor antagonist, feneridone, is recommended, which has demonstrated renal and cardiovascular benefits.