Diabetic kidney disease in type 2 diabetes: a consensus statement from the Swiss Societies of Diabetes and Nephrology

Zanchi, Anne; Jehle, Andreas W.; Lamine, Faïza; Vogt, Bruno; Czerlau, Cecilia; Bilz, Stefan; Seeger, Harald; Seigneux, Sophie de

doi:10.57187/smw.2023.40004

Cited by 6 publications

(3 citation statements)

References 111 publications

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“…The main pathogenetic basis of NASH on the background of DM is a violation of the sensitivity of insulin receptors to membranes of insulin-sensitive organs (liver and skeletal muscle) to the hormone, disorders of transport and utilization of glucose from the circulatory system [15,16].…”

Section: Discussionmentioning

confidence: 99%

The glycemic profile in patients with non-alcoholic steatohepatitis and type 2 diabetes depending on diabetic kidney disease

Kotsiubiichuk,

Antoniv,

Khukhlina

2023

Mìžnarodnij endokrinologìčnij žurnal

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Background. State of carbohydrate metabolism and severity of insulin resistance in the comorbid course of non-alcoholic steatohepatitis (NASH) and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (DM2) is due to the cascade of possible transformation of NASH into liver cirrhosis. The purpose is to study the interaction of changes in glucose and insulin homeostasis, the degree of insulin resistance and insulin sensitivity, the degree of hemoglobin glycosylation on the clinical course of NASH associated with DM depending on the presence of DKD and its stage. Materials and methods. One hundred and eight patients with NASH and comorbid DM2 were examined. The average age of patients was 58.2 ± 6.1 years. There were 63 women (58.3 %) and 45 men (41.7 %). Depending on the presence of DKD, 4 groups of patients were formed, who were randomized by age, sex, activity of cytolytic syndrome. The comparison group consisted of 30 healthy individuals of the appropriate age and sex. The degree of hepatic steatosis and its nature were determined using SteatoTest, ASH and NASH-Test kits (BioPredictive, France). The stage of liver fibrosis was determined using FibroTest (BioPredictive, France), a set of markers for quantitative biochemical evaluation of fibrosis. Results. In patients with NASH, DM2 and DKD stage I–II, we found a significant decrease in serum albumin by 9.0 % (p < 0.05); glomerular filtration rate (GFR) and urine albumin, on the contrary, increased significantly, by 1.5 times (p < 0.05) compared to those in the control group, which indicates the phenomenon of hyperfiltration and is specific to the initial stage of DKD. When NASH is combined with DM2 and DKD stage III, a significant decrease in serum albumin by 1.2 times (p < 0.05) is reported; GFR and albuminuria were significantly increased, by 1.4 and 11.7 times (p < 0.05), respectively, compared to the control group. In patients with NASH, DM2 and DKD stage IV, we found a significant decrease in serum albumin by 1.4 times (p < 0.05), it was significantly increased by 30.2 times (p < 0.05) compared to the indicator in the control group, and the GFR, on the contrary, was significantly reduced by 1.7 times (p < 0.05), which indicates the progression of DKD. Conclusions. Disorders of glucose homeostasis due to insulin resistance are one of the probable risk factors for the progression of non-alcoholic steatohepatitis and type 2 diabetes mellitus in the presence of stage I–IV diabetic kidney disease.

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Section: Discussionmentioning

confidence: 99%

The glycemic profile in patients with non-alcoholic steatohepatitis and type 2 diabetes depending on diabetic kidney disease

Kotsiubiichuk,

Antoniv,

Khukhlina

2023

Mìžnarodnij endokrinologìčnij žurnal

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“…This medication has been clinically proven to reduce cardiovascular events and the progression of chronic kidney disease ( 73 ). Recently, guidelines ( 74 – 77 ) reflect growing recognition of finerenone’s clinical benefits and increasingly emphasize the need for earlier intervention strategies that concurrently target cardiorenal protection in patients with coexisting diabetes, kidney disease and cardiovascular illness.…”

Section: Treatment Strategies For Dnmentioning

confidence: 99%

Unveiling the pathogenesis and therapeutic approaches for diabetic nephropathy: insights from panvascular diseases

Zhang,

Ren

et al. 2024

Front. Endocrinol.

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Diabetic nephropathy (DN) represents a significant microvascular complication in diabetes, entailing intricate molecular pathways and mechanisms associated with cardiorenal vascular diseases. Prolonged hyperglycemia induces renal endothelial dysfunction and damage via metabolic abnormalities, inflammation, and oxidative stress, thereby compromising hemodynamics. Concurrently, fibrotic and sclerotic alterations exacerbate glomerular and tubular injuries. At a macro level, reciprocal communication between the renal microvasculature and systemic circulation establishes a pernicious cycle propelling disease progression. The current management approach emphasizes rigorous control of glycemic levels and blood pressure, with renin-angiotensin system blockade conferring renoprotection. Novel antidiabetic agents exhibit renoprotective effects, potentially mediated through endothelial modulation. Nonetheless, emerging therapies present novel avenues for enhancing patient outcomes and alleviating the disease burden. A precision-based approach, coupled with a comprehensive strategy addressing global vascular risk, will be pivotal in mitigating the cardiorenal burden associated with diabetes.

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“…Лікування пацієнтів із ХХН та ЦД 2-го типу є однією з найважливіших мультидисциплінарних проблем сучасної діабетології, і воно суттєво змінилось з позицій доказової медицини протягом останніх десятиліть. Хоча сучасні методи лікування сповільнюють зниження ниркової функції, кількість пацієнтів з термінальною стадією ниркової недостатності, вторинною по відношенню до діабету, як і раніше, зростає у всьому світі через високу поширеність діабету, ожиріння та старіння населення [23].…”

Section: вступunclassified

New possibilities of nephroprotection in type 2 diabetes using finerenone Consensus of the board of experts

Mankovsky,

Sayenko,

Bilchenko

et al. 2023

DOMS

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Patients with chronic kidney disease (CKD) belong to the category of patients with diabetes mellitus (DM), which are the most difficult to treat. They require a multidisciplinary, multifactorial approach to slow disease progression, reduce glomerular filtration rate (GFR), and prevent cardiovascular morbidity and mortality. Modern treatment of CKD in patients with type 2 diabetes involves influencing various links of its pathogenesis. The use of finerenone is a fundamentally new approach in treatment of CKD. Inflammation and fibrosis, which develop as a result of excessive activation of mineralocorticoid receptors, are key pathophysiological mechanisms of the development and progression of CKD in patients with type 2 DM. Therefore, the blocking of mineralocorticoid receptors (MCR) with the innovative nonsteroidal selective MCR antagonist finerenone is a promising way to improve the clinical course of CKD, and has a favorable prognostic effect on the rate of progression of CKD and on the risk of cardiovascular events. The feasibility of adding finerenone to the treatment regimens of patients with CKD and type 2 diabetes in order to reduce the rate of progression of CKD and reduce the frequency of cardiovascular events is substantiated by convincing data from clinical studies and reflected in the recommendations of the American Diabetes Association, 2023. The innovative drug finerenone has a direct nephroprotective effect, which reliably slows down the progression of CKD in patients with type 2 diabetes. Therefore, finerenone should be considered for prescribing from the initial stage of kidney damage. When using finerenone, the risk of developing hyperkalemia is low, which minimizes the risk of withdrawal of the drug during treatment. Despite the available modern methods of treatment, which are primarily aimed at the hemodynamic and metabolic factors of the development of CKD in type 2 diabetes mellitus, the introduction of the specified new pathogenetic approach using finerenone, as a means whose mechanism of action is due to a direct effect on inflammation and fibrosis, is considered necessary from the point of view of improving the clinical course of CKD and the prognosis.

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Diabetic kidney disease in type 2 diabetes: a consensus statement from the Swiss Societies of Diabetes and Nephrology

Cited by 6 publications

References 111 publications

The glycemic profile in patients with non-alcoholic steatohepatitis and type 2 diabetes depending on diabetic kidney disease

The glycemic profile in patients with non-alcoholic steatohepatitis and type 2 diabetes depending on diabetic kidney disease

Unveiling the pathogenesis and therapeutic approaches for diabetic nephropathy: insights from panvascular diseases

New possibilities of nephroprotection in type 2 diabetes using finerenone Consensus of the board of experts

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