慢性肾脏病合并糖尿病的治疗

Treatment of chronic kidney disease with diabetes mellitus

慢性肾脏病（CKD）合并糖尿病的治疗措施包括生活方式干预、降糖、降压、降脂、抗血小板及肾脏替代治疗。所有治疗遵循安全、有效、个体化原则。生活方式干预强调低盐低蛋白饮食。治疗药物的选择及剂量的调整应基于药物的药代动力学特征及肾功能水平。降糖药利格列汀、格列吡嗪、吡格列酮可全程应用于CKD无需调整剂量。降压治疗首选肾素血管紧张素醛固酮系统阻滞剂。对于CKDG1~4期患者,推荐启用他汀类药物。抗血小板治疗首选阿司匹林,不能耐受或有禁忌证者以氯吡格雷替代。透析启动时机与非糖尿病CKD患者相同。

Treatment strategy in diabetic patients with chronic kidney disease（CKD）includes lifestyle intervention,glycemic control,blood pressure-lowering therapy,lipid-lowering therapy,antiplatelet therapy and renal replacement therapy.All treatments follow the principle of safety,effectiveness and individualization.Lifestyle intervention focuses at the restriction of salt and protein intake.Drug selection and dose adaptation should be based on the pharmacokinetic characteristics and the renal function.Linagliptin,glipizide and pioglitazone can be used through the CKD process without dose adjustment. RAAS inhibitors should be considered as an initial therapy for hypertension.Statin is recommended in diabetic patients with CKD of stage 1to 4.Aspirin is recommended as the first choice for antiplatelet therapy and clopidogrel is an alternative for aspirin in patients with clear intolerance or contraindications for aspirin.Dialysis is initiated in patients with diabetes on the same criteria as in those without diabetes.