Revista Clínica Española (English Edition) Revista Clínica Española (English Edition)
Rev Clin Esp 2018;218:305-15 - Vol. 218 Num.6 DOI: 10.1016/j.rceng.2018.03.010
Review
Clinical assessment and treatment of diabetes in patients with chronic kidney disease
Evaluación clínica y tratamiento de la diabetes en pacientes con enfermedad renal crónica
J. Carretero Gómez, , J.C. Arévalo Lorido
Servicio de Medicina Interna, Hospital Comarcal de Zafra, Badajoz, Spain
Received 04 March 2018, Accepted 19 March 2018
Abstract

Diabetes mellitus type 2 is the main cause of chronic kidney disease. Patients with this disease have higher morbidity and mortality and risk of hypoglycaemia than those without this disease. In 2010, type 2 diabetes was the reason for starting renal replacement therapy in 24.7% of patients. The prevalence of microalbuminuria, proteinuria and a reduced glomerular filtration rate is 36%, 8% and 22%, respectively. The presence of albuminuria is a predictor of chronic kidney disease. Diabetic kidney disease, previously known as diabetic nephropathy, refers to kidney disease caused by diabetes. Renal hyperfiltration is a marker of intraglomerular hypertension and a risk factor for onset and progression. The new antidiabetic drugs, mainly dipeptidyl peptidase-4 inhibitors, sodium-glucose cotransporter inhibitors and glucagon-like peptide-1 agonists, have been shown to prevent or slow the progression of kidney disease.

Resumen

La diabetes mellitus tipo2 es la principal causa de enfermedad renal crónica. Estos pacientes presentan mayor morbimortalidad y riesgo de hipoglucemias que el resto. En 2010, la diabetes tipo2 fue causa del inicio de terapia renal sustitutiva en el 24,7% de los pacientes. La prevalencia de microalbuminuria, proteinuria y disminución del filtrado glomerular es del 36, 8, y 22%, respectivamente. La presencia de albuminuria es un factor predictivo de enfermedad renal crónica. La enfermedad renal diabética, previamente conocida como nefropatía diabética, hace referencia a la enfermedad renal causada por la diabetes. La hiperfiltración renal es marcador de hipertensión intraglomerular y factor de riesgo tanto de inicio como de progresión. Los nuevos antidiabéticos, fundamentalmente los inhibidores del enzima dipeptidil peptidasa-4, los inhibidores del cotransportador de sodio/glucosa y los agonistas del péptido similar al glucagón tipo1, han demostrado prevenir o enlentecer la progresión de la enfermedad renal.

Keywords
Diabetes, Chronic kidney disease, Diabetic nephropathy, Diabetic kidney disease, SGLT2-i, GLP-1RA, DPP4-i
Palabras clave
Diabetes, Enfermedad renal crónica, Nefropatía diabética, Enfermedad renal del diabético, iSGLT2, arGLP1, iDPP4

Article

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Rev Clin Esp 2018;218:305-15 - Vol. 218 Num.6 DOI: 10.1016/j.rceng.2018.03.010
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