2022版《ADA/KDIGO共识报告:慢性肾脏病患者的糖尿病管理》要点解读

Interpretation of Diabetes Management in Chronic Kidney Disease:a Consensus Report by the American Diabetes Association(ADA)and Kidney Disease:Improving Global Outcomes(KDIGO)

糖尿病和慢性肾脏病(CKD)患者是肾衰竭、动脉粥样硬化性心血管疾病、心力衰竭和过早死亡的高危人群。美国糖尿病协会(ADA)和改善全球肾脏病预后组织(KDIGO)成立联合专家小组,根据ADA 2022年发布的糖尿病管理标准和KDIGO 2022年发布的《KDIGO临床实践指南:慢性肾脏病患者的糖尿病管理》中基于证据的CKD患者糖尿病管理建议进行整合,形成了2022版《ADA/KDIGO共识报告:慢性肾脏病患者的糖尿病管理》(简称共识)。该共识不仅重新强调了已发布指南更新的CKD筛查和诊断、血糖监测、生活方式干预、治疗目标和药物管理内容,还特别强调了健康生活方式基础上的药物治疗综合管理的重要性。该共识声明了7项核心建议,对肾素-血管紧张素系统抑制剂、二甲双胍、钠-葡萄糖共转运蛋白-2抑制剂、胰高血糖素样肽1受体激动剂和非甾体盐皮质激素受体拮抗剂的使用提供了具体指导,为改善糖尿病合并CKD患者临床结局的管理提供了明确方向。本文对该共识的主要内容进行解读,以期为临床医生提供简洁、实用的指导,改善糖尿病合并CKD患者的预后。

People with diabetes and chronic kidney disease(CKD)are at high risk for kidney failure,atherosclerotic cardiovascular disease,heart failure,and premature mortality.The American Diabetes Association(ADA)and the Kidney Disease:Improving Global Outcomes(KDIGO)established joint group,and integration of evidence-based recommendations for diabetes management in patients with CKD in accordance with the ADA 2022 standards of medical care in diabetes and KDIGO 2022 Clinical Practice Guideline for Diabetes Management in CKD,and to form the Diabetes Management in Chronic Kidney Disease:a Consensus Report by the ADA and KDIGO.The consensus not only re-emphasizes the published guidelines for screening and diagnosis of CKD,glycemia monitoring,lifestyle therapies,treatment goals,and pharmacologic management,but also specifically emphasizes the importance of comprehensive care in which pharmacotherapy based on a foundation of healthy lifestyle.The consensus states seven core recommendations which provide specific guidance for the use of renin-angiotensin system inhibitors,metformin,sodium-glucose cotransporter-2 inhibitors,glucagon-like peptide 1receptor agonists,and a nonsteroidal mineral corticoid receptor antagonist.These areas of consensus provide clear direction for implementation of care to improve clinical outcomes of people with diabetes and CKD.Focusing on the main contents of the consensus,we interpreted main recommendations in order to provide concise and practical guidance for clinicians,to achieve the goal of improving the prognosis of patients with diabetes mellitus complicated with CKD.