Tus Tshiab Non-steroidal MRA Qhib Tus Qauv Tshiab Rau Kev Kho Mob Ntshav Qab Zib Raum Hauv Suav Teb

Thaum lub Plaub Hlis 11-15, 2023, American Kidney Foundation (NKF) Spring Clinical Meeting (SCM23) yuav muaj nyob rau hauv Austin! Raws li lub ntiaj teb thawj tus tshiab non-steroidal xaiv mineralocorticoid receptor antagonist (MRA) finerenone tau pom zoo rau kev kho mob ntawm hom 2 mob ntshav qab zib mellitus (T2D) ntsig txog kab mob raum (CKD), raws li nws lub raum kom meej, cov pov thawj ntawm lub plawv yuav pab tau. thawj zaug tau txais kev pom zoo rau kev lag luam hauv Tebchaws Meskas thaum Lub Xya Hli 2021. Ntawm lub rooj sib tham no, cov ntaub ntawv tshawb fawb hauv ntiaj teb tiag (RWD) ntawm finerenone, tom qab nws tau tshaj tawm hauv Tebchaws Meskas, tau tso tawm, muab cov ntaub ntawv tseem ceeb rau kev siv tshuaj kho mob. finerenone nyob rau hauv lub ntiaj teb no tiag tiag!

Nyem rau cistanche herba rau mob raum

Los ntawm RCTs rau RWDs: finerenone muaj kev siv dav dav

Three published landmark studies—FIDELIO-DKD, FIGARO-DKD, and FIDELITY studies have fully confirmed that finerenone has a clear renal and cardioprotective effect on T2D-related CKD patients and is also safe1-3. Focusing on the early clinical practice of finerenone, a retrospective observational study was released at this conference to analyze the characteristics of initial users of finerenone after it was commercially launched in the United States. This study analyzed the relevant data of the US HealthCore comprehensive research database and included 568 T2D-related CKD patients treated with finerenone, with an average age of 65±11.6 years, and 40% of them were female. In stage b or stage 4, 43% of patients had urinary albumin/creatinine ratio (UACR) >300 mg/g. Cov neeg mob comorbidities: kub siab (92 feem pua), dyslipidemia (85 feem pua), kab mob coronary artery (29 feem pua), thiab plawv tsis ua hauj lwm (17 feem pua). Cov tshuaj sib xyaw ua ke tseem ceeb: cov tshuaj tiv thaiv ntshav siab (95 feem pua), cov tshuaj hypoglycemic (81 feem pua), thiab statins (79 feem pua), ntawm cov uas siv cov renin-angiotensin-aldosterone system (RAAS) inhibitors ntau dua (80 feem pua), cov proportions ntawm cov neeg mob uas siv angiotensin-hloov enzyme inhibitors (ACEI) thiab angiotensin receptor blockers (ARB) nyob rau hauv qhov kev pom zoo koob tshuaj yog 59 feem pua ​​thiab 74 feem pua. Kev xaiv thawj koob tshuaj ntawm finerenone: 3/4 ntawm cov neeg mob tau pib koob tshuaj 10 mg, thiab cov neeg mob tau pib koob tshuaj 20 mg. Rau cov kws kho mob tshuaj finerenone: Cov kws kho mob nephrologist yog cov kws kho mob ntau tshaj plaws (34 feem pua), tom qab ntawd los ntawm cov kws kho mob thawj (27 feem pua) thiab endocrinologist (14 feem pua).

Cov txiaj ntsig ntawm qhov kev soj ntsuam rov qab no tau pom tseeb tias finerenone muaj ntau yam kev siv tshuaj kho mob hauv kev hloov pauv sai ntawm theem III kev tshawb fawb soj ntsuam mus rau kev kho mob. Raws li cov ntaub ntawv kho mob tiag tiag hauv Tebchaws Meskas, nws tuaj yeem pom tias muaj kev xav tau ceev ceev rau finerenone txawm tias tus neeg mob lub raum tsis zoo nyob rau theem 1-2 lossis theem 3-4; ntawm lawv, kev tswj cov proteinuria yog qhov tseem ceeb tshaj plaws ntawm tus kab mob. Qhov tseem ceeb ntawm cov tshuaj noj thaum ntxov ntawm finerenone, nyob rau hauv kev kho mob tiag tiag, ze li ntawm 60 feem pua ​​​​ntawm cov neeg mob uas muaj microalbuminuria kuj siv finerenone rau active intervention. UACR yog ib qho cim ntawm kev raug mob raum thaum ntxov, thiab nws qhov nce siab muaj feem cuam tshuam nrog kev pheej hmoo ntawm lub raum raug mob thiab cov xwm txheej hauv plawv5-7. Yog li ntawd, UACR tuaj yeem suav tau tias yog ib qho ntawm cov cim tseem ceeb rau kev kuaj mob ntxov thiab kev cuam tshuam ntawm T2D ntsig txog CKD cov neeg mob. Cov lus qhia tag nrho hais txog qhov tseem ceeb ntawm UACR kev tswj hwm thiab qhia meej tias lub hom phiaj ntawm kev tswj hwm ntawm T2D-txog CKD yog UACR<30mg/g8-10. The clinical management of early UACR is of great significance. Phase III FIDELIO-DKD, FIGARO-DKD, and FIDELITY studies have jointly confirmed that for early to late T2D-related CKD patients, finerenone can significantly reduce UACR by more than 30%, and the effect lasts 1 -3. The FIDELITY study also confirmed that among patients with different baseline UACR/eGFR, finerenone can bring consistent renal and cardiac benefits, and early users will benefit as soon as possible3.

Tsis tas li ntawd, cov neeg mob T2D-txog CKD feem ntau cuam tshuam nrog kev kub siab thiab dyslipidemia, uas yuav tsum muaj kev tswj hwm ntawm ntau yam tshuaj, thiab kev sib xyaw ntawm ntau yam tshuaj yuav tsum tau saib xyuas cov tshuaj sib cuam tshuam. Finerenone tsis cuam tshuam rau cov neeg mob ntshav siab thiab ntshav qab zib, thiab tsis tas yuav kho cov phiaj xwm kho tam sim no kom txo qis ntshav siab thiab ntshav qab zib, yog li nws yooj yim rau kev siv tshuaj kho mob.

Tsis tas li ntawd, RWD tseem qhia tau tias cov neeg mob CKD muaj feem cuam tshuam nrog T2D tau faib rau ntau lub tuam tsev. Yog li ntawd, nws yog ib qho tsim nyog yuav tsum tau ntxiv dag zog rau kev sib txuas lus ntau yam thiab kev sib koom tes hauv kev kho mob kom cuam tshuam sai li sai tau thiab txhim kho kev soj ntsuam. Kev sib koom tes sib koom ua ke tau ua lub luag haujlwm tseem ceeb hauv kev paub txog ntau lub kaum sab xis thiab ntau theem kev tswj hwm ntawm CKD. Lub tsev kho mob yuav tsum suav nrog thiab sib koom tes los daws cov teeb meem ntawm T2D ntsig txog CKD. Nws cia siab tias finerenone yuav tau txais txiaj ntsig ntau dua rau tib neeg raws li cov kws kho mob cov tshuaj. Ntau tus neeg mob T2D ntsig txog CKD.

Kev tsom mus rau kev xyaum kho mob, ntxiv kev nkag siab tshiab rau kev kho mob ntshav qab zib thiab kab mob raum hauv Suav teb

Tus kab mob lub nra ntawm CKD yog hnyav hauv Suav teb, uas yog ib qho tseem ceeb ua rau muaj ntau yam kabmob. Nrog rau kev nce ntxiv ntawm T2D, T2D-koom nrog CKD tau dhau los ua thawj lub tsev kho mob ua rau CKD hauv Suav teb 11,12. 25 feem pua ​​-40 feem pua ​​​​ntawm cov neeg mob ntshav qab zib yuav tsim CKD, thiab CKD tuaj yeem ua rau muaj kev pheej hmoo ntawm atherosclerotic cardiovascular kab mob hauv cov neeg mob T2D. txaus ntshai kab mob plawv, plawv tsis ua hauj lwm, thiab tag nrho cov ua rau tuag13. Piv nrog rau cov neeg sab hnub poob, cov neeg Esxias T2D feem ntau ua ke nrog CKD thiab proteinuria, thiab qib proteinuria siab dua. Cov neeg Esxias T2D ntsig txog CKD kuj tseem muaj kev pheej hmoo siab dua ntawm cov kab mob raum kawg (ESRD)14-17, thiab qhov xav tau kev kho mob sai dua.

Finerenone yog lub ntiaj teb thawj hom tshiab uas tsis yog-steroidal xaiv MRA pom zoo rau kev kho mob ntawm T2D-txog CKD. Nws tuaj yeem ua tiav lub hom phiaj thiab inhibit qhov kev ua haujlwm ntau dhau ntawm MR, tawm dag zog tiv thaiv thiab tiv thaiv fibrosis los tswj cov proteinuria ncaj qha, thiab tom qab ntawd paub txog lub raum ua haujlwm. Lub plawv ob txoj kev tiv thaiv. Txoj kev tshawb fawb FIDELITY yog qhov loj tshaj plaws theem III txoj kev kawm nrog cov pej xeem dav tshaj plaws hauv thaj tsam ntawm T2D-txog CKD txog tam sim no hauv ntiaj teb. Cov txiaj ntsig ntawm txoj kev tshawb fawb tau lees paub tias finerenone muaj cov txiaj ntsig zoo rau lub raum thiab lub plawv thiab kev nyab xeeb hauv ntau tus neeg hauv G1-G4 theem: Raws li kev kho mob RASi siab tshaj plaws thiab kev tswj ntshav siab thiab ntshav qab zib, finerenone tuaj yeem txo qhov kev pheej hmoo ntawm lub raum sib xyaw qhov kawg ntawm 23 feem pua ​​​​, thiab txo qhov kev pheej hmoo ntawm cov kab mob plawv los ntawm 14 feem pua. Tom qab 4 lub hlis ntawm kev kho mob, qhov tseem ceeb txo UACR mus txog 32 feem pua, thiab cov nyhuv kho tau kav ntev li 3. Nyob rau tib lub sijhawm, tag nrho kev nyab xeeb ntawm finerenone yog piv rau cov placebo, tsis muaj kev phiv cuam tshuam txog kev sib deev cov tshuaj hormones, Kev cuam tshuam ntawm cov ntshav cov poov tshuaj tsuas yog 0.19 mmol / L, thiab qhov feem pua ​​​​ntawm cov tshuaj tshem tawm vim hyperkalemia tsuas yog 1.7 feem pua, uas yooj yim rau kev tswj hwm kev kho mob 3.

Raws li cov ntaub ntawv ntawm cov pej xeem Suav, cov txiaj ntsig ntawm FIDELIO-DKD Suav subgroup txoj kev tshawb fawb tau lees paub tias finerenone tuaj yeem txo qhov kev pheej hmoo ntawm tus txheeb ze ntawm qhov kawg ntawm cov xwm txheej hauv lub raum loj hauv Suav cov neeg mob los ntawm 41 feem pua ​​18; World Congress of Nephrology (WCN) nyuam qhuav tshaj tawm xyoo no FIDELITY-Asian subgroup cov ntaub ntawv qhia tau hais tias piv nrog cov placebo, finerenone txo qhov kev pheej hmoo ntawm lub raum puas kawg ntawm 34 feem pua, thiab txo qhov kev pheej hmoo ntawm lub raum tsis ua haujlwm los ntawm 35 feem pua. Cov neeg Esxias, suav nrog cov neeg mob raum, kuj muaj cov txiaj ntsig zoo rau lub raum19, thiab ntau qhov muag pom cov pov thawj-raws li cov ntaub ntawv pov thawj muab cov tswv yim tshiab rau kev tswj cov proteinuria hauv Suav cov neeg mob T2D ntsig txog CKD thiab ua kom muaj txiaj ntsig ntawm kev mob raum. !

Finerenone has now entered the stage of widespread clinical application, and how to rationally apply it to maximize the benefits of patients is a hot spot in clinical practice. Based on evidence-based support and guideline recommendations, in clinical practice, for T2D-related CKD patients with eGFR>25mL / min / 1.73m2 nrog rau cov proteinuria (UACR Ntau dua lossis sib npaug rau 30mg / g), cov ntshav liab<5.0mmol/L, it is recommended to If SGLT2i is used, finerenone therapy should be initiated as soon as possible to improve the management of proteinuria and achieve dual protection of kidney and heart. Since finer enone's-renal and heart benefits are independent of blood pressure and hypoglycemic treatments, phase III studies have shown that finerenone has the greatest impact on systolic blood pressure of 3.7mmHg, has no effect on blood sugar and body weight, and does not affect basic medication does not increase the risk of urinary tract infection in the elderly population1-3, and can effectively take into account both efficacy and safety for elderly people who do not need to adjust the hypoglycemic regimen, non-obese (BMI<30kg/m2) patients, and aged ≥65 years old1-3 20. It is recommended to directly combine finerenone treatment based on RASi treatment.

The usage and dosage of finerenone should be selected according to the patient's eGFR level. For patients with eGFR ≥ 60ml/min/1.73m2, the standard dose can be directly started at 20mg; for patients with eGFR 25-60ml/min/1.73m2, start with a half dose of 10mg, and after 4 weeks of treatment, if the blood potassium is normal and the eGFR decline is not more than 30% compared with the baseline, adjust the dose to the standard dose of 20mg, once a day orally. 20. Phase II ARTS-DN study showed that finerenone significantly reduced UACR in a dose-dependent manner, and did not significantly increase the risk of hyperkalemia over a wide dose range21. In clinical practice, it should be noted that blood potassium should be monitored regularly after finerenone treatment, and it is recommended to monitor blood potassium at 1 month, 4 months after initial treatment, and every 4 months thereafter20. If the patient's serum potassium>5.5mmol/L, suspend the use of finerenone, wait for 72 hours after the blood potassium level returns to normal, and then start finerenone at ha alf dose of 10mg; if the patient's serum potassium>5. zoorenone.

Cov ntsiab lus

SCM 23 lub rooj sib tham tau ua tiav tiav, thiab kev tshawb fawb hauv ntiaj teb tiag ntawm finerenone tom qab nws tau tsim tawm hauv Tebchaws Meskas thiab tso tawm ntawm lub rooj sib tham tau coj qhov cuam tshuam tseem ceeb rau kev kho mob. Raws li ib qho ntawm cov teb chaws uas muaj lub nra hnyav ntawm tus kab mob CKD, piv nrog cov tebchaws nyob sab hnub poob, Tuam Tshoj muaj cov neeg mob coob, thiab kev pheej hmoo ntawm kev kis kab mob thiab cov kab mob plawv ib txhij yog siab dua. Yog li ntawd, muaj kev xav tau ceev ceev rau cov txheej txheem muaj zog uas txheeb xyuas cov kev cuam tshuam ntawm cov proteinuria thiab cov txiaj ntsig rau lub raum-lub plawv. Finerenone yog lub ntiaj teb thawj hom tshiab uas tsis yog-steroidal MRA tau pom zoo rau kev kho mob ntawm T2D-txog CKD. Nws tuaj yeem ua tiav lub hom phiaj thiab inhibit qhov kev ua kom ntau dhau ntawm MR, tawm dag zog los tiv thaiv kab mob thiab tiv thaiv fibrosis kom ncaj qha tswj cov proteinuria, thiab tom qab ntawd paub txog lub raum-lub plawv Qhov kev tiv thaiv ob zaug tau txhawb nqa kev tswj hwm ntawm cov piam thaj hauv ntshav mus rau qib tshiab. ntawm proteinuria tswj uas ncaj qha hits lub ntsiab ntawm tus kab mob! Tam sim no, finerenone tau ua lag luam hauv ntau lub teb chaws, thiab Tuam Tshoj cov ntawv pov hwm kho mob tau nkag mus rau theem ntawm kev siv tshuaj kho mob thoob plaws. Muab cov pov thawj-raws li koob hmoov ntawm pab pawg neeg cov ntaub ntawv ntawm cov neeg mob Suav nyob rau hauv FIDELIO-DKD txoj kev tshawb fawb thiab cov neeg Esxias cov ntaub ntawv ntawm FIDELITY txoj kev tshawb no, ua ke nrog cov yam ntxwv ntawm Suav T2D hais txog cov neeg mob CKD, cov kev soj ntsuam daim ntawv thov kev cia siab ntawm finerenone nyob rau hauv Tuam Tshoj yog dav, nws yuav ua rau lub raum zoo thiab lub plawv zoo rau cov neeg mob Suav, thiab ntxiv ntau xim kom txo tau lub nra ntawm tus kab mob CKD hauv Suav teb!

Lub Mechanism ntawm Cistanche kho raum kab mob

Cistanche yog ib hom tshuaj suav tshuaj uas tau siv ntau pua xyoo los kho cov kab mob raum. Nws ua haujlwm los ntawm kev txhawb kev tsim cov erythropoietin, ib yam tshuaj uas txhawb kev tsim cov qe ntshav liab. Qhov no yuav pab txhim kho lub raum ua haujlwm los ntawm kev ua kom muaj peev xwm nqa oxygen ntawm cov ntshav. Tsis tas li ntawd, Cistanche muaj cov tebchaw uas muaj cov tshuaj tiv thaiv kab mob thiab antioxidant, uas tuaj yeem pab txo qhov mob thiab oxidative kev nyuaj siab hauv lub raum. Qhov no tuaj yeem pab tiv thaiv ob lub raum los ntawm kev puas tsuaj ntxiv thiab txhawb kev kho mob. Cistanche kuj muaj cov khoom diuretic, uas tuaj yeem pab ua kom cov zis tso zis ntau ntxiv thiab txo cov kua dej hauv lub cev. Qhov no tuaj yeem muaj txiaj ntsig zoo rau cov neeg muaj kab mob raum uas tuaj yeem muaj qhov o thiab ua kua dej. Zuag qhia tag nrho, cov txheej txheem ntawm Cistan hauv kev kho mob raum cuam tshuam nrog kev txhim kho lub raum ua haujlwm, txo qhov mob thiab oxidative kev nyuaj siab, thiab txhawb kev diuresis.