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.
Keywords: type 2 diabetes mellituschronic kidney diseasecarbohydrate metabolismoral anti-diabetic drugsinsulinadverse events