Rozpoznawanie i leczenie cukrzycy typu 2 u chorych z przewlekłą chorobą nerek i wartością eGFR < 60 ml/min — opinia członków Grupy Roboczej Polskiego Towarzystwa Nefrologicznego ds. Zaburzeń Metabolicznych i Hormonalnych w Chorobach Nerek

Abstract

Diabetes mellitus remains the most frequent co-morbid conditions in patients with chronic kidney disease (CKD) frequently leading to chronic kidney failure. Progression of CKD triggers several meta-bolic disorders, including those related to carbohy­drate metabolism. Patients with CKD are character­ized by an insulin resistance, additionally aggravated by several co-morbid conditions (such as for exam-ple chronic low-grade inflammation). Treatment with anti-diabetic medications in patients with CKD remains a challenge, since along with the progres­sion of a disease dosing of several drugs needs to be adjusted (especially of those which are excreted with urine intact or as active metabolites). CKD pro­gression also increases the risk of hypoglycemia in patients treated with anti-diabetic drugs and other adverse drug reactions. Usefulness of the new gen­eration drugs has not yet been verified in patients with advanced kidney disease (although some of them act through the kidney-related mechanisms). The current position statement of the Polish Society of Nephrology Working Group provides the practical guidelines for the diagnosis and treatment of type 2 diabetes mellitus in patients with CKD.