PDF(Pubmed)
Abstract：
The glucagon-like peptide-1 receptor agonists (GLP-1RA) are among the newest treatment options available for managing of type 2 diabetes mellitus and slowing the progression of diabetes kidney disease (DKD). Subcutaneous (SC) semaglutide (Ozempic®) is a GLP-1RA with an extended half-life of approximately 1 week. GLP-1RA are highly effective in improving glycemic control and also show other beneficial effects such as increased natriuresis; decreased blood pressure and albuminuria; reduction of oxidative stress and inflammation; delay of gastric emptying and suppress appetite; the latter may result in significant weight loss. GLP-1RA can be used in patients with advanced-stage CKD; the European Medicines Agency has approved the use of all commercially available human GLP-1 analogs up to a minimal eGFR of 15 mL/min/1.73 m2. However, studies of safety and use of these agents in renal replacement therapy are scarce. Therefore, herein we present 3 cases of patients with advanced DKD in maintenance incremental hemodialysis with 1 session per week to describe the efficacy and safety of the SC semaglutide treatment and the favorable effects on glycemic control, lowering HbA1c, albuminuria, weight, blood pressure control, and preservation of residual kidney function (RKF) during a 6-month follow-up in a hospital hemodialysis unit in Spain. These effects could produce an improvement in morbidity and mortality and could also prevent albuminuria and preserve the RKF. This may allow our patients to maintain a weekly hemodialysis session and could facilitate their inclusion in the kidney transplant waiting lists.
摘要：
胰高血糖素样肽-1受体激动剂(GLP-1RA)是可用于管理2型糖尿病和减缓糖尿病肾病(DKD)进展的最新治疗选择之一。皮下（SC）司马鲁肽（Ozempic®）是一种GLP-1RA，半衰期延长约1周。GLP-1RA在改善血糖控制方面非常有效，并且还显示出其他有益作用，例如尿钠增多；降低血压和白蛋白尿；减少氧化应激和炎症；延迟胃排空并抑制食欲；后者可能导致明显的体重减轻。GLP-1RA可用于晚期CKD患者；欧洲药品管理局已批准使用所有市售的人GLP-1类似物，最高eGFR为15mL/min/1.73m2。然而,关于这些药物在肾脏替代治疗中的安全性和使用的研究很少。因此,本文中，我们介绍了3例DKD患者在维持性增量血液透析中，每周1次，以描述SC司马鲁肽治疗的疗效和安全性以及对血糖控制的有利作用，降低HbA1c，白蛋白尿,体重,血压控制,在西班牙一家医院血液透析病房进行的6个月随访中，保留残余肾功能（RKF）。这些作用可以改善发病率和死亡率，还可以预防蛋白尿并保留RKF。这可能使我们的患者能够维持每周的血液透析疗程，并有助于将其纳入肾脏移植等待名单。
