A New Pollar Nan Ren-Kè Terapi Pou CKD Konplike Ak T2DM
Jul 11, 2023
Sou Jen 15-18, 2023, 60th European Renal Association (ERA) Kongrè a te ofisyèlman ki te fèt nan Milan, Itali a konbinezon /sou entènèt ak offline. reyinyon 9,{{{{{{{{{{{{{{{{{{{{{{{%.b4}} scholars diskite devlopman ak rechèch rezilta rezilta renney maladi a kontni kouvri klinik ren maladi 2c debaz medikaman medikaman 2c dyabetik nephropathy, ak aspècts, bay a ra ra aprann aprann opòtinite pou klinik travayè yo.
Klike sou to cistanche tubulosa dosage pou kidney maladi
Prévalence kwonik ren maladi (CKD) konbine ak kalite 2 2 dyabèt mellitus (T2DM) segondè, ki seryezman menas lavi ak sante nan pasyan yo. Sa a ERA konferans, Pwofesè Giuseppe Grandaliano soti nan Itali prezide seminar seminar 22Non-Steroidal MRAs: A New Pillar Nan Kidney-Heart Terapi CKD Konplike T2DM", konsantre konsantre "Guideline Rekòmandasyon Update *Ki pa Peye-Steroidal MRA" Twa sijè "2arly ki pa stewoyid MRA" ak "double benefis ki pa stewoyid MRA pou ren kè" 22 yo te prezante.
nouvo ki pa stewoyidal MRA dirèkteman esans maladi a ede CKD CKD konbine ak T2DM benefis rendey
In the past 40 years, the treatment of CKD combined with T2DM has been greatly developed. In the past, blood pressure management was represented by renin-angiotensin system inhibitors (RASi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) Although the representative blood glucose management has improved the ability to delay the progression of CKD to a certain extent, the residual renal and cardiac risks are still high, and the renal progression has not been completely stopped1. In this symposium, Professor Beatriz Fernández-Fernández from Spain first emphasized the importance of the new therapeutic target mineralocorticoid receptor (MR) in CKD combined with T2DM disease and pointed out that MR is in the heart, kidney, and vascular system Overactivation may lead to tissue remodeling, dysfunction, inflammation, and fibrosis2, therefore, inhibition of MR overactivation is an important therapeutic strategy to improve renal inflammation, fibrosis, and reduce cardiovascular risk. The new non-steroidal highly selective MRA finerenone can directly, accurately, and comprehensively antagonize the overactivation of MR, block the inflammation and fibrosis of the kidney and heart, and bring double benefits to patients3. It has become a new pillar in the treatment of CKD combined with T2DM. In addition, the innovative structure of finerenone effectively circumvents the deficiencies of traditional steroidal MRA in many aspects such as molecular structure, efficacy, and safety, and it is powerful and has better safety and tolerance3.
Based on the unique mechanism of action, the clinical efficacy of finerenone has been fully verified. The first phase III study FIDELIO-DKD confirmed that finerenone can delay the progression of kidney disease and reduce the occurrence of CV events in patients with moderate to severe CKD complicated with T2DM4. Subsequently, another large phase III study, FIGARO-DKD, provided strong evidence for the benefit of kidney and heart in patients with early CKD and T2DM (Figure 1). In addition, the landmark FIDELITY study is a pooled analysis of finerenone FIDELIO and FIGARO studies, and it is also the largest phase III study of CKD combined with T2DM in the world and the most extensive coverage of the population, covering CKD stages 1-4, urinary albumin For a wide range of people with a creatinine ratio (UACR) of 30-5000 mg/g, studies have shown that based on maximizing RASi treatment and achieving blood pressure and blood sugar targets, finerenone can still further significantly reduce the risk of renal composite endpoints by 23 percent . , significantly reducing the risk of composite cardiovascular endpoints by 14 percent 6. Through its unique mechanism of action, finerenone directly hits the essence of the disease and realizes the dual benefits of the kidney and heart. It has become a new pillar for the treatment of CKD combined with T2DM that directly targets proteinuria management after blood sugar and blood pressure management.
Figi 1 FIDELIO-DKD ak FIGARO-DKD syans: finerenone gen tou de renney ak benefis
Bonè finerenone ka siyifikativman amelyore pronostik la nan pasyan yo
CKD konbine ak T2DM main main nan fen-etap renal failure. Yon fwa pasyan pwoteyin etap renal domaj définition ranvèse, sijere sijere enpòtans tretman direktiv pwen si CKD ka detekte ak trete bonè maladi kontwole ranvèse7.
In this symposium, Professor Christoph Wanner from Germany emphasized the importance of early treatment of CKD combined with T2DM and elicited the benefits of early treatment through a case. Professor Rajiv Agarwal from the United States also emphasized the importance of UACR in the early management of diseases through this case, pointing out that UACR, as an important marker of kidney injury and heart and kidney risk, can appear early in the course of the disease8, and can be used clinically not only for The screening and diagnosis of chronic kidney disease9-10 can also assess and predict the progression of kidney disease and the risk of cardiovascular death11-12, which are important indications for the application of renoprotective drugs. Many guidelines at home and abroad recommend regular monitoring of albuminuria in patients with CKD and T2DM and take albuminuria management as one of the treatment goals10,13-14. Professor Rajiv Agarwal also analyzed the FIGARO-DKD phase III study of finerenone. Among the patients included in the FIGARO-DKD study, 62 percent had albuminuria (median UACR 308 mg/g) but renal function remained unchanged (eGFR Greater than or equal to 60 ml/min/1.73 ㎡), 46 percent were accompanied by moderate albuminuria increase (UACR 30~<300 mg/g), the results showed that after 4 months of finerenone treatment, UACR was significantly reduced by 32 % (HR 0.68; 95% CI, 0.65-0.70), and the effect was sustained (Figure 2). It is suggested that the management of finerenone on albuminuria is helpful to advance the treatment of CKD combined with T2DM, and provides an effective means for early intervention5.
Figi 2 FIGARO-DKD etid: Finerenone siyifikativman diminye UACR
Pwofesè Rajiv Agarwal tou pwente ki albuminuria, kòm yon endepandan predictor renal pwogresyon ak cardiovascular maladi%)ta dwe kouri jesyon nan CKD konbine ak T2DM. Syans gen montre 30 pousan rediksyon rediksyon UACR% 2c risk risk pwogresyon pral redwi 27 pousan 15 (Figi 3). Amelyorasyon of UACR pa ka reta ren progression, men diminye CV Mòtalite ak dyaliz pousantaj, prolong pasyan siviv, ak diminye tretman costs16. St gen montre ke finerenone ka siyifikativman amelyore kadyovaskilè rezilta ak diminye risk CV lanmò18 (Figi 4), ak li afekte pa baseline UACR.
Figi 3 UACR rediksyon reta renal progresion
Figure 4 Finerenone reduces the risk of CV-related death regardless of the patient's baseline UACR
rekòmande estati finerenone gid kontinye monte
Based on abundant clinical evidence, finerenone has been recommended by many authoritative guidelines including ADA, KDIGO, AHA, and AACE (Figure 5), and its status in the field of CKD combined with T2DM is constantly rising. Prof. Beatriz Fernández-Fernández explained in detail the changes in the US ADA guidelines for finerenone recommendations (Figure 6), emphasizing the importance of finerenone in the treatment of CKD combined with T2DM. In the 2022 edition of ADA Diabetes Diagnosis and Treatment Standards, regarding the treatment of CKD combined with T2DM, finerenone made its debut and was strongly recommended: For CKD patients with increased risk of cardiovascular events or CKD progression, or who cannot use SGLT2i, it is recommended to use non- Steroidal MRA finerenone to reduce the risk of CKD progression and cardiovascular events (level A recommendation) 9. In May 2022, ADA added some content to the "diabetes diagnosis and treatment standard": strongly recommend finerenone for Patients with CKD and T2DM who have received the maximum tolerated dose of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) to improve cardiovascular prognosis and reduce the risk of CKD progression (Grade A Recommendation) 19. In January 2023, the latest version of "ADA Diabetes Diagnosis and Treatment Standards" was released. Compared with the previous version, the new version of the guideline improved the status of non-steroidal MRA in the management of CKD combined with T2DM, and it is recommended together with other drugs As a basic treatment to provide renal and heart protection, rather than as an alternative treatment when other treatments are ineffective, the specific recommendations are: For patients with CKD with albuminuria who have cardiovascular events or increased risk of CKD progression, it is recommended to use clinical trials to prove effective Non-steroidal MRA to delay the progression of CKD and reduce the occurrence of cardiovascular events (Grade A recommendation) 13 (Figure 2). The changes in the ADA guidelines for the recommended treatment of finerenone reflect the rising status of finerenone in clinical application and will benefit more patients with CKD and T2DM.
Figure 5 Finerenone is recommended by multiple international guidelines
Figi 6 ADA Gid la rekòmandasyon rekòmandasyon pou finerenone yo toujou ap mete ajou
Rezime
Pou yon tan tan, CKD konbine ak T2DM te yon sante nan global concern. Strengthening jesyon nan albuminuria, pwomosyon entèvansyon entèvansyon entèvansyon nan maladi a ak bonè dwòg ak klè ren ak benefis efikas jesyon metòd pou CKD konbine ak T2DM. ki pa peye-stewoyid MRA finerenone acts sib la rendey 2c egzèsis anti-inflamatory ak anti-fibroz efè, efektivman diminye albuminuria, reta ren pwogresyon ak amelyore CV prognosis. Based li yo inovatè mekanis action abundant abondan prèv prèv 2c li te jwenn Plizyè entènasyonal autorité rekòmande ede CKD konbine T2DM benefis rendey ak kè a.
Kòman Cistanche trete ren maladi/maladi?
Cistanche se yon tradisyonèl Chinwa èrbal medsin itilize trete trete divès kalite sante sante kondisyon, ki gen ladan ren Li li se sòti soti nan tij Cistanche deserticola, plant natif natal Cistanche deserticola, plant cistanche Cistanche deserticola, plant tij Cistanche deserticola, plant tij Cistanche deserticola, plant cistanche deserticola, plant tij Cistanche deserticola, plant desè Lachin ak Mongoli. main aktif konpozan cistanche phenylethanoid glycosides, echinacoside, ak acteoside, ki yo te gen benefisye benefisye rendey sante.
Renney maladi, tou li te ye kòm renal maladi refers a kondisyon nan ki ren yo yo fonksyone Sa a rezilta rezilta a buildup bati batidup nan gaspiye ak toxins kò a dirijan divès kalite sentòm ak complications. Cistanche ka trete ren maladi ase nan plizyè mekanis mekanism.
Premye% 2c cistanche te jwenn gen gen dyurèk pwopriyete 2c siyifikasyon li ka ogmante pipi pwodiksyon elimine pwodwi Sa a soulaje fado sou ren ak anpeche buildup toxins. By pwomosyon disisis, cistanche ede Diminye san tansyon 2c complication complication ren maladi.
Anplis de sa, 2c cistanche te jwenn gen anti-inflamatory effects. Inflamation se yon lòt kle faktè devlopman pwogresyon nan renney maladi. Cistanche's anti-infla Pwopriyete ede diminye pwodiksyon pro-inflamatory cytokines ak inhibit activation inflamation obligatwa chemen 2c konsa soulaje inflamation ren yo.
Anplis de sa, 2c cistanche te te montre gen immunomodulatory effects. /Renney maladi, imune ka dysregulated, dirijan twòp enflamasyon ak tissue domaj. Cistanche ede re imune repons pa modulation pwodiksyon ak aktivite imune selil 2c t t cells macrophages. Sa iminitè règleman help diminye enflamasyon ak anpeche plis domaj ren yo.
Moreover, cistanche te amelyore amelyore fonksyon pwomosyon rejenerasyon renal tubes ak cells. Renal tubular epithelith jwe jwe yon kritik nan filtraj ak reabsorption tete eli 2c rendey maladi, sa yo cells domaje, digamage domaje renal fonction. Cistanche's ankouraje rejenerasyon cells cells restore restore proper renal fonksyon ak amelyore an jeneral ren sante.
Nan adisyon sa yo efè ren yo cistanche te jwenn gen benefisye efè lòt ògàn Sa holistic apwòch sante patikilyèman /nan ren maladi%.2c as kondisyon souvan afekte miltip ògàn ak systems. che te gen gen efè fwa a fwa, kè, ak veso veso, ki yo souvan afekte pa ren maladi maladi. By pwomosyon sante sa yo ògàn, cistanche ede amelyore an jeneral ren fonksyon ak anpeche plis konplikasyon.
In konklizyon, cistanche se yon tradisyonèl Chinwa medsin medsin trete trete kidney maladi. Lis aktif components gen diretik, antioksidan, anti-enflamatwa, immunomodulatory, ak 2c efè, ki ede amelyore renal fonksyon pwoteje ren yo pli lwen domaj. 2c cistanche benefisye efè ògàn ògàn ak sistèm yo fè yon holistic trete trete ren maladi maladi.
Referans pou konnen plis anlè moun sa a -
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