对糖尿病肾病患者实施新型肾脏保护和心脏保护疗法的挑战与策略

IF 2.8 3区 医学 Q2 UROLOGY & NEPHROLOGY Seminars in nephrology Pub Date : 2024-03-01 DOI:10.1016/j.semnephrol.2024.151520
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引用次数: 0

摘要

慢性肾脏病(CKD)发病率很高,据估计,全球有超过 8 亿人患有慢性肾脏病。糖尿病是导致肾病的主要原因。糖尿病和慢性肾脏病都与心血管疾病的高风险以及相关的发病率和死亡率有关。在过去的几年里,人们开始将重点转向整合肾脏和心血管护理,尤其是糖尿病。钠-葡萄糖共转运体 2 抑制剂、胰高血糖素样肽 1 受体激动剂和非类固醇矿皮质激素受体拮抗剂已迅速成为糖尿病和慢性肾脏病患者肾脏和心血管风险护理的基石。然而,目前这些药物的使用率很低,而且不同种族、民族、年龄、性别和合并症之间的使用差异也很明显。实施肾脏保护和心脏保护疗法所面临的挑战包括:糖尿病和慢性肾脏病筛查率低、医疗服务提供者缺乏舒适感和对亚专科的依赖、各专业协会的指南不一致、停药率高以及成本过高。要有效实施肾脏保护和心脏保护疗法,就必须采取多方面的方法,并让患者、药剂师、初级医疗服务提供者、亚专科医疗服务提供者和医疗保健系统领导者等主要利益相关者积极参与进来。实施工作应切实可行,并结合以多学科团队为基础的协作方法。成功实施肾脏保护和心脏保护疗法有可能改善总体健康状况,并缩小医疗保健差距。
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Challenges and Strategies in Implementing Novel Kidney Protective and Cardioprotective Therapies in Patients With Diabetes and Kidney Disease

Chronic kidney disease (CKD) is highly prevalent, estimated to affect over 800 million people worldwide. Diabetes is a leading cause of kidney disease. Both diabetes and CKD are associated with a high risk of cardiovascular disease and related morbidity and mortality. Over the last several years, there has been a shift in focus toward integrating kidney and cardiovascular care, particularly in diabetes. Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists have rapidly become cornerstones of kidney and cardiovascular risk-focused care in diabetes and CKD. However, present-day use of these agents is low, and disparities in use by race, ethnicity, age, sex, and comorbidities are apparent. Challenges in implementation of kidney protective and cardioprotective therapies include low rates of diabetes and CKD screening, lack of provider comfort and subspecialty reliance, inconsistencies across professional society guidelines, high rates of drug discontinuation, and prohibitive costs. Effective implementation of kidney protective and cardioprotective therapies necessitates a multifaceted approach and active engagement of patients, pharmacists, primary care providers, subspecialty providers, and health care system leaders as key stakeholders. Implementation efforts should be practical and incorporate collaborative, multidisciplinary team-based approaches. Successful implementation of kidney protective and cardioprotective therapies has the potential to improve overall health outcomes and ameliorate health care disparities.

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来源期刊
Seminars in nephrology
Seminars in nephrology 医学-泌尿学与肾脏学
CiteScore
5.60
自引率
0.00%
发文量
27
审稿时长
6-12 weeks
期刊介绍: Seminars in Nephrology is a timely source for the publication of new concepts and research findings relevant to the clinical practice of nephrology. Each issue is an organized compendium of practical information that serves as a lasting reference for nephrologists, internists and physicians in training.
期刊最新文献
Table of Contents Editorial Board Masthead Electronic Collection of Patient-Reported Outcomes to Improve Kidney Care: Benefits, Drawbacks, and Next Steps Patient-Reported Outcomes to Achieve Person-Centered Care for Aging People With Kidney Disease
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