Finerenone Txhawb T2D-txog CKD Kev Tswj Xyuas rau Qib Tshiab

Qhov kev txiav txim ntawm lub xyoo feem ntau hloov, thiab tshooj yog rov ua dua ib hnub dhau ib hnub. Thaum lub caij nplooj ntoo hlav lig thiab lub caij ntuj sov thaum ntxov, World Congress of Nephrology (WCN) thiab 21st Congress ntawm Asia-Pacific Society of Nephrology (APCN) yuav muaj nyob hauv Bangkok, Thaib teb txij lub Peb Hlis 30 txog Lub Plaub Hlis 2, 2023! Ib pawg ntawm cov neeg txawj ntse, cov neeg muaj zog, thiab ntau tus kws tshaj lij thiab cov kws tshawb fawb nrog cov kev paub nplua nuj thiab kev ua tiav zoo hauv thaj chaw ntawm nephrology tau pom lub koob tsheej zoo tshaj plaws!

cistanche benefits and side effects

Nyem rau cistanche koob tshuaj rau mob raum mob

Raws li qhov chaw kub kub hauv thaj tsam ntawm cov kab mob raum ntev (CKD) ntsig txog hom 2 mob ntshav qab zib mellitus (T2D) hauv ob xyoos dhau los, tus tshiab mineralocorticoid receptor antagonist (MRA) finerenone ci ntsa iab ntawm WCN lub rooj sib tham.

Los ntawm lub hauv paus theoretical mus rau lub tswv yim tshiab, los ntawm cov pov thawj-raws li cov ntaub ntawv pov thawj mus rau cov lus pom zoo, cov kws tshaj lij hauv cheeb tsam tau hais lus zoo heev ntawm finerenone. Hauv qhov teeb meem no, xibfwb Zhou Yilun los ntawm Beijing Tiantan Tsev Kho Mob Koom Tes nrog Capital Medical University, thiab xibfwb Zhou Xiaoshuang los ntawm Shanxi Provincial Tsev Kho Mob tau caw tshwj xeeb los muab kev txhais lus zoo ntawm kev kawm hotspots ntsig txog finerenone ntawm lub rooj sib tham no.

Finerenone muaj txiaj ntsig rau lub raum tseem ceeb hauv cov neeg Esxias

Ua raws li FIDELIO-DKD Tuam Tshoj subgroup cov ntaub ntawv txheeb xyuas cov txiaj ntsig tau luam tawm los ntawm American Society of Nephrology (ASN) xyoo tas los, nws tau pom tias nyob rau hauv Suav cov pej xeem, finerenone txo qis lub raum sib xyaw qhov kawg ntawm cov xwm txheej (lub raum tsis ua haujlwm, eGFR txuas ntxiv poob ntau dua. los yog sib npaug li 40 feem pua piv nrog cov hauv paus ntsiab lus) feem pua lossis mob raum tuag) kev pheej hmoo ntawm cov txheeb ze mus txog 41 feem pua 1, nrog rau cov txiaj ntsig zoo rau lub raum, ntawm lub rooj sib tham no, FIDELITY tau teev tseg cov pab pawg ua ntej kev soj ntsuam cov txiaj ntsig ntawm kev kho mob finerenone ntawm Asian T2D-txog CKD Cov neeg mob lub raum thiab mob plawv tau tshaj tawm thawj zaug!

Cov txiaj ntsig tau pom tias, piv nrog cov placebo, finerenone tuaj yeem txo qhov kev pheej hmoo ntawm lub raum sib xyaw qhov kawg tshwm sim hauv cov neeg Esxias los ntawm 34 feem pua (HR 0.66; 95 feem pua CI 0.52–{{ 6}}.84; Daim duab 1), thiab qhov kev pheej hmoo ntawm CV sib xyaw cov kev tshwm sim los ntawm 1{{10}} feem pua (HR 0.66; 95 feem pua CI 0}.52 -0.84; Daim duab 1). 0.90; 95% CI 0.70-1.15; Daim duab 1), cov txiaj ntsig ntawm lub raum thiab lub plawv ntawm cov neeg mob tau zoo ib yam nrog cov neeg tsis yog neeg Esxias (kev sib cuam tshuam P qhov tseem ceeb yog 0.08 thiab 0.88, feem) 2.

Piv nrog rau cov neeg tsis yog neeg Asian, lub raum txiaj ntsig ntawm cov neeg Esxias tseem ceeb dua! Hauv ib lub raum tshwm sim, qhov kev pheej hmoo ntawm lub raum tsis ua haujlwm raug txo los ntawm 35 feem pua (HR 0.65; 95 feem pua Cl 0.49-0.87; P kev sib cuam tshuam=0 . ; 95 feem pua Cl 0.

echinacea

Daim duab 1 Finerenone txo qhov kev pheej hmoo ntawm lub raum thiab cov hlab plawv cov ntsiab lus kawg hauv cov neeg Esxias

Xibfwb Zhou Yilun tau taw qhia tias cov ntaub ntawv tshawb fawb neeg Esxias cov ntaub ntawv luam tawm ntawm lub rooj sib tham WCN xyoo no tau qhia tias, piv nrog cov placebo, finerenone txo qis qhov kev pheej hmoo ntawm lub raum sib xyaw kawg ntawm 34 feem pua, thiab txo qhov kev pheej hmoo ntawm lub raum tsis ua haujlwm los ntawm 35 feem pua 2; piv nrog cov neeg tsis yog neeg Esxias, Finerenone tau pom cov txiaj ntsig zoo rau lub raum hauv cov neeg Esxias, ntxiv cov pov thawj tshiab rau kev tiv thaiv lub raum hauv cov neeg Esxias!

Ua ke nrog cov txiaj ntsig ntawm FIDELIO-DKD Suav pawg kev tshawb fawb tau luam tawm nyob rau xyoo 2022 ASN, cov ntaub ntawv pov thawj ntawm cov txiaj ntsig zoo ntawm lub raum rau cov neeg Esxias, tshwj xeeb tshaj yog cov pej xeem Suav, muaj ntau dua, muab peb txoj hauv kev kho mob zoo heev rau cov neeg Esxias. Kev kho mob ntawm T2D ntsig txog CKD.

Qhov no ua rau peb cov kws kho mob muaj kev ntseeg siab hauv kev siv cov tshuaj no kom txo tau qhov tshwm sim ntawm lub raum thiab mob plawv thiab ncua kev loj hlob ntawm cov neeg mob mus rau theem kawg ntawm lub raum kab mob (ESKD). Peb kuj tseem tos ntsoov ntau heev kom finerenone tuaj yeem tau txais txiaj ntsig ntau dua T2D-txog CKD cov neeg mob.

Rov qab mus rau hauv keeb kwm, lub tswv yim tshiab ntawm finerenone tau tso lub hauv paus ruaj khov rau nws cov pov thawj zoo-raws li. Kev ua kom ntau dhau ntawm cov mineralocorticoid receptor (MR) yog xav tias ua rau mob thiab fibrosis, ua rau lub raum thiab mob plawv 3-6. Tus tshiab MRA finerenone ncaj qha mus rau lub hom phiaj, zoo txo cov proteinuria, ncua kev loj hlob ntawm lub raum kab mob, paub txog kev tiv thaiv ob lub raum thiab lub plawv 7,8 puv qhov sib txawv nyob rau hauv kev kho mob ntawm T2D-txog CKD thiab txhawb kev kho mob ntshav siab tswj thiab ntshav qab zib. kev tswj kom ncaj qha mus tua cov ntsiab lus ntawm tus kab mob Ib theem tshiab ntawm kev tswj!

Lub zeem muag ntawm kev soj ntsuam rational daim ntawv thov ntawm finerenone yog dav

Pib ntawm theem siab, mus ncig tsis muaj ciam teb, ua tiav hauv kev sib koom, thiab ua tiav kev ua tiav. Nyob rau hauv ib qho chaw kawm ntawv muaj zog, qhov teeb meem kub ntawm kev soj ntsuam rational thov ntawm finerenone thawb lub rooj sib tham mus rau qhov kawg. Dosing regimen yog lub hom phiaj ntawm kev kho mob. Rau cov neeg uas tsis tau noj ACEi lossis ARBs ua ntej, puas yuav ACEi lossis ARBs raug muab qhov tseem ceeb hauv kev kho mob, lossis yuav tsum tsis yog-steroidal MRA (xws li finerenone) raug siv ncaj qha? Los yog siv SGLT-2 inhibitors? Thiab cov tshuaj no ua haujlwm ua ke li cas?

Hauv qhov no, xibfwb Roberto Pecoits-Filho, los ntawm Department of Nephrology ntawm Catholic University of Parana, Brazil, tau hais tias ib qho ntawm cov teeb meem rau cov kws kho mob yog los txhais cov ntaub ntawv sib tham hauv lub ntiaj teb tiag tiag.

rou cong rong

Txhawm rau teb cov lus nug no, nws yuav tsum tau ua tib zoo xav txog ntau yam xws li kev muaj cov tshuaj hauv zos, teeb meem ntawm tus nqi, tus kws kho mob nyiam, kev xaiv yav dhau los thiab kev ua siab ntev ntawm cov neeg mob, thiab kev tswj hwm tshuaj ib leeg. Lwm tus kws kho mob uas koom nrog tau qhia tias raws li ib nrab ntawm lub neej ntawm finerenone ntawm 2 mus rau 3 teev, kev kho mob ntau zaus yuav ua rau muaj kev tiv thaiv kab mob zoo dua? Xib fwb Roberto Pecoits-Filho ntseeg hais tias qhov no yog qhov tshwj xeeb ntawm cov tsis-steroidal xaiv MRA: nws sai sai ua rau cov receptor, thiab tom qab ntawd ua rau cov yam ntxwv zoo sib xws ntawm cov noob qhia thiab cov lus teb nqes. Tsawg kawg hauv txoj kev xav, qhov kev xaiv muaj zog dua, kev tiv thaiv lub raum thiab cov hlab plawv zoo dua, thiab nws kuj tseem tuaj yeem txo qhov tshwm sim tsis zoo.

Xib fwb Zhou Xiaoshuang tau taw qhia tias tam sim no, peb qhov kev tshawb fawb tseem ceeb ntawm finerenone - cov kev tshawb fawb FIDELIO, FIGARO, thiab FIDELITY tau raug tso tawm ua ke kom paub meej tias cov tshuaj rau lub raum thiab cardioprotective cuam tshuam rau T2D-txog CKD cov neeg mob thiab nws txoj kev nyab xeeb zoo 9- 11 .

Yuav ua li cas kom ua tau zoo ntawm cov tshuaj nyob rau hauv kev kho mob daim ntawv thov yog ib lo lus nug tsim nyog xav txog. Cov txiaj ntsig kho mob ntawm finerenone yog ywj siab ntawm kev kho mob ntshav siab thiab hypoglycemic thiab tuaj yeem pib ncaj qha raws li kev kho mob uas twb muaj lawm. Rau cov neeg mob kho nrog RASi lossis RASi ntxiv rau SGLT2i, kev sib xyaw ua ke ntawm finerenone tseem tuaj yeem pom cov txiaj ntsig ntawm lub raum thiab mob plawv, txo qis cov zis albumin-to-creatinine piv (UACR), thiab txo qhov kev pheej hmoo ntawm hyperkalemia12-15.

Because hyperkalemia has always been a hot topic of clinical concern, safe medication is very important. When the patient's serum potassium is >5. 0 mmol/L thiab eGFR<25 mL/min/1.73㎡, finerenone is not recommended16. At the same time, individualized medication is also essential. The clinical efficacy of finerenone is dose-dependent, and the target dose is 20 mg, which can be adjusted based on blood potassium levels and eGFR. Pay attention to monitoring the changes in values during medication16.

Cov kev tshawb fawb saum toj no tag nrho tau lees paub tias qhov tshwm sim ntawm qhov kev ncua mus tas li vim hyperkalemia thiab mus pw hauv tsev kho mob vim hyperkalemia hauv cov neeg mob kho nrog finerenone yog tsawg, qhia tias finerenone siv rau ntau tus neeg thiab tau txais txiaj ntsig zoo los ntawm cov neeg mob. tswj, qhov zeem muag ntawm daim ntawv thov kev kho mob yog dav heev 9-11.

Coincidentally, finerenone tau siv nyob rau hauv Tuam Tshoj txoj kev pov hwm kho mob, uas tau txo qis nyiaj txiag lub nra ntawm cov neeg mob thiab txhim kho kev nkag tau zoo ntawm cov tshuaj. Nws yog tam sim no nyob rau theem ntawm kev thov sai thiab dav. , cia siab tias finerenone yuav txuas ntxiv mus ntxiv cov kev paub hauv Suav kev kho mob yav tom ntej, thiab dhau los ua cov tshuaj yooj yim rau kev kho mob T2D ntsig txog CKD.

Cov ntsiab lus

WCN'23 lub rooj sib tham tau ua tiav tiav, thiab cov ntsiab lus hais txog kab mob raum tau kiv taub hau. Kev sib koom zoo ntawm cov kws tshaj lij yuav pab txhim kho cov kev kuaj mob thiab kev kho mob ntawm cov kws kho mob hauv kev kho mob ntshav qab zib thiab kab mob raum, thiab pab txhawb cov txheej txheem kev tswj hwm ntawm T2D ntsig txog CKD.

echinacoside

Txawm hais tias tus kab mob lub nra ntawm T2D-txog CKD hnyav, qhov kev sib tw hauv chaw kho mob hnyav, thiab txoj kev ntev thiab txoj kev ntev, cov kws tshawb fawb hauv thaj teb tsis tau tso tseg kev tshawb nrhiav. Cov kev kho mob cuam tshuam rau kev ncua kev nce qib ntawm T2D ntsig txog CKD tau txuas ntxiv tsim nyob rau hauv 40 xyoo dhau los. Niaj hnub no, los ntawm txoj kev xav mus rau cov pov thawj-raws li, tus tshiab MRA finerenone tuaj yeem ncua kev loj hlob ntawm cov kab mob raum, thiab muab kev tiv thaiv ob lub raum thiab lub plawv zoo rau cov neeg mob T2D ntsig txog CKD, tshwj xeeb tshaj yog rau cov neeg Esxias, suav nrog cov neeg Suav, qhov sib txawv. Cov txiaj ntsig ntawm lub raum yog qhov pom tseeb dua 1,2!

Cov txiaj ntsig no yog qhov zoo siab heev. Finerenone tau pom nws lub zog nyuaj nrog cov ntaub ntawv tshawb fawb zoo, uas tuaj yeem hais tau tias tau muab Tuam Tshoj T2D-txog CKD teb rau "cov tshuaj tiv thaiv". Txoj kev npaj kho mob uas siv tau zoo heev thiab tuaj yeem muab kev tiv thaiv ob lub raum thiab lub plawv, thaum txo qis kev lag luam ntawm cov neeg mob, thiab ua tiav qhov kev yeej-yeej ntawm qhov chaw kho mob tus nqi thiab kev siv nyiaj. Kev kho mob ntawm T2D-txog CKD yog nyob ntawm romantic "cov tshuaj", cia saib tam sim no!

Dab tsi yog qhov mechanism ntawm Cistanche kho mob raum?

Cistanche yog ib tsob nroj uas nquag siv hauv tshuaj suav tshuaj los kho mob raum. Lub tshuab uas nws ua haujlwm tsis nkag siab tag nrho, tab sis nws xav tias muaj cov teebmeem hauv qab no:

1. Anti-inflammatory: Cistanche muaj cov tshuaj uas muaj cov tshuaj tiv thaiv kab mob. Kab mob raum feem ntau cuam tshuam nrog kev mob, yog li txo qhov mob tuaj yeem txhim kho lub raum ua haujlwm.

2. Antioxidant: Cistanche yog nplua nuj nyob rau hauv antioxidants uas yuav pab tiv thaiv lub raum los ntawm kev puas tsuaj los ntawm dawb radicals.

3. Immunomodulatory: Cistanche tau pom tias yuav hloov kho lub cev tiv thaiv kab mob, uas tuaj yeem pab txo lub raum mob thiab kev puas tsuaj.

4. Anti-fibrotic: Cistanche tuaj yeem pab tiv thaiv kev tsim cov caws pliav hauv ob lub raum, uas tuaj yeem tshwm sim hauv qee yam kab mob raum.

Zuag qhia tag nrho, qhov tseeb mechanism uas Cistanche ua haujlwm los txhim kho lub raum kev ua haujlwm tseem tab tom kawm, tab sis nws cov tshuaj tiv thaiv kab mob, antioxidant, immunomodulatory, thiab cov tshuaj tiv thaiv fibrotic tuaj yeem ua rau nws cov teebmeem kev kho mob.

cistanche herba

Siv:

1. Cov txiaj ntsig ntawm Finerenone ntawm CKD Cov txiaj ntsig hauv Hom 2 Ntshav Qab Zib: Ib pawg Suav Kev Tshawb Fawb ntawm FIDELIO-DKD Txoj Kev Kawm. 2022 UAS. Poster: SA-PO2

2. CARDIORENAL OTCOMES nrog FINERENONE nyob rau hauv ASIAN cov neeg mob uas muaj mob raum kab mob thiab hom 2 mob ntshav qab zib: A preSPECIFIED SUB-analysis los ntawm FIDELITY. WCN 23. Poster:0618.

3. Kolkhof P, et al. Pharmacol Res. 2021 Peb; 172:105859.

4.Bauersachs J, et al. Br J Pharmacol. 2022; 179(13): 3119–3134.

5.Barrier-Chimal J, et al. Raum Int. 2019;96(2):{5}}

6.Nishiyama A. Hypertens Res. 2019;42(3):293-3

7. Clarisse D, et al. Br J Pharmacol. 2022; 179(13): 3235–3249.

8. Agarwal R, et al. Eur Heart J. 2021;42(2):152-161.

9.Bakris GL, et al. N Engl J Med. 2020; 383(23): 2219–2

10. Pitt B, et al. N Engl J Med. 2021 Dec 9; 385(24):{5}}.

11. Agarwal R, et al. European Heart Journal. 2021; 1-1 [ PubMed ]

12. Rossing P, thiab al. Mob Ntshav Qab Zib. 2022 Aug 15: dc2

13. Rssing P, et al. ASN 2021; Abstract SA-OR22.

14.McGill J. Scientific symposium nthuav tawm ntawm European Association rau Kev Kawm Ntshav Qab Zib