HAC (Russian)
RSCI (Russian)
Ulrichsweb (Ulrich’s Periodicals Directory)
Scientific Indexing Services

Renin-angiotensin-aldosterone system blockers for diabetic nephropathy

DOI: https://doi.org/10.29296/25877305-2021-10-03

Professor A. Bagriy, MD; Associate Professor M. Khomenko, Candidate of Medical Sciences, E.
Mikhailichenko, Candidate of Medical Sciences M. Gorky Donetsk National Medical University, Donetsk, Donetsk
People’s Republic / Ukraine

Diabetic nephropathy (DNP) is associated with a high risk of end-stage renal failure and an unfavorable cardiovascular prognosis, which requires strict blood pressure and glycemic control in this patient category. The paper discusses whether it is inexpedient to use the single term «DNP» denoting all cases of chronic kidney disease (CKD) in patients with diabetes mellitus (DM), since about 30-50% of patients with both types of DM and a glomerular filtration rate

clinical nephrology
diabetes mellitus
diabetic nephropathy
renin-angiotensin-aldosterone system blockers

  1. 1. Algoritmy spetsializirovannoj meditsinskoj pomoschi bol'nym saharnym diabetom. 9-j vyp. (dop.). Pod red. I.I. Dedova, M.V. Shestakovoj, A.Ju. Majorova. Saharnyj diabet. 2019; 22 (S1): 1–213 [Standards of specialized diabetes care. 9th ed.(revised). Ed. by I.I. Dedov, M.V. Shestakova, A.Yu. Maiorov. Diabetes mellitus. 2019; 22 (S1): 1–213 (in Russ.)]. DOI: 10.14341/DM221S1
  2. 2. Arhipov E.V., Oschepkova O.B., Sineglazova A.V. i dr. Porazhenie pochek pri metabolicheskih narushenijah (ozhirenie, metabolicheskij sindrom, diabet, podagra i dr.). Nefrologija. 2019; 23 (S1): 75–88 [Arkhipov E.V., Oschepkova O.B., Sineglazova A.V. et al. Kidney damage in metabolic disorders (obesity, metabolic syndrome, diabetes mellitus, gout, etc.). Nephrology (Saint-Petersburg). 2019; 23 (S1): 75–88 (in Russ.)]. DOI: 10.36485/1561-6274-2019-23-5-75-88
  3. 3. Eknoyan G., Lameire N., Wheeler D.C. et al. KDIGO Clinical Practice Guideline on Diabetes Management in Chronic Kidney Disease. URL: https://kdigo.org/wp-content/uploads/2018/03/KDIGO-Diabetes-Management-in-CKD_Public-Review.pdf
  4. 4. Pugliese G., Penno G., Natali A. et al. Diabetic kidney disease: new clinical and therapeutic issues. Joint position statement of the Italian Diabetes Society and the Italian Society of Nephrology on «The natural history of diabetic kidney disease and treatment of hyperglycemia in patients with type 2 diabetes and impaired renal function». J Nephrol. 2020; 33 (1): 9–35. DOI: 10.1007/s40620-019-00650-x
  5. 5. Neumiller J.J., Bakris G., Cefalu W.T. et al. Professional Practice Committee: Standards of Medical Care in Diabetes, 2020. Diabetes Care. 2020; 43 (S1): S3. DOI: 10.2337/dc20-SPPC
  6. 6. Rawshani A., Rawshani A., Franzen S. et al. Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med. 2018; 379: 633–44. DOI: 10.1056/NEJMoa1800256
  7. 7. Markova T.N., Sadovskaja V.V., Bespjatova M.Ju. Sovremennye vozmozhnosti diagnostiki hronicheskoj bolezni pochek pri saharnom diabete. Saharnyj diabet. 2017; 20 (6): 454–60 [Markova T.N., Sadovskaya V.V., Bespyatova M.Y. Modern methods of diagnosing chronic kidney disease in patients with diabetes mellitus. Diabetes mellitus. 2017; 20 (6): 454–60 (in Russ.)]. DOI: https://doi.org/10.14341/DM9268
  8. 8. Dobronravov V.A., Shestakova M.V. Diabeticheskaja nefropatija. V kn.: Nefrologija. Natsional'noe rukovodstvo. Pod red. N.A. Muhina. M.: GEOTAR-Media, 2016; c. 337–49 [Dobronravov V.A., Shestakova M.V. Diabeticheskaya nefropatiya. In: Nefrologiya. Natsional’noye rukovodstvo. Ed. N.A. Mukhin. M.: GEOTAR-Media, 2016; p. 337–49 (in Russ.)].
  9. 9. Alicic R.Z., Rooney M.T., Tuttle K.R. Diabetic kidney disease: challenges, progress, and possibilities. Clin J Am Soc Nephrol. 2017; 12 (12): 2032–45. DOI: 10.2215/CJN.11491116
  10. 10. Kopel J., Pena-Hernandez C., Nugent K. Evolving spectrum of diabetic nephropathy. World J Diabetes. 2019; 10 (5): 269–79. DOI: 10.4239/wjd.v10.i5.269
  11. 11. Doshi S.M., Friedman A.N. Diagnosis and management of type 2 diabetic kidney disease. Clin J Am Soc Nephrol. 2017; 12: 1366–73. DOI: 10.2215/CJN.11111016
  12. 12. Sarnak M.J., Amann K., Bangalore S. et al. Chronic Kidney Disease and Coronary Artery Disease. J Am Coll Cardiol. 2019; 74 (14): 1823–38. DOI: 10.1016/j.jacc.2019.08.1017
  13. 13. Tomilina N.A. Hronicheskaja bolezn' pochek. Izbrannye glavy nefrologii. M.: GEOTAR-Media, 2017; 136 s. [Tomilina N.A. Khronicheskaya bolezn’ pochek. Izbranniye glavi nefrologii. M.: GEOTAR-Media, 2017; 136 r. (in Russ.)].
  14. 14. Bilo H., Coentrao L., Couchoud C. et al. Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR
  15. 15. Farrah F.E., Dhillon B., Keane P.A. et al. The eye, the kidney, and cardiovascular disease: old concepts, better tools, and new horizons. Kidney Int. 2020; 98 (2): 323–42. DOI: 10.1016/j.kint.2020.01.039
  16. 16. Georgianos P.I., Agarwal R. Revisiting RAAS blockade in CKD with newer potassium-binding drugs. Kidney Int. 2018; 93 (2): 325–34. DOI: 10.1016/j.kint.2017.08.038
  17. 17. Imai E., Chan J.C., Ito S. et al. Effects of olmesartan on renal and cardiovascular outcomes in type 2 diabetes with overt nephropathy: a multicentre, randomised, placebo-controlled study. Diabetologia. 2011; 54 (12): 2978–86. DOI: 10.1007/s00125-011-2325-z
  18. 18. Ruiz-Ortega M., Rodrigues-Diez R.R., Lavoz C. et al. Special Issue «Diabetic Nephropathy: Diagnosis, Prevention and Treatment». J Clin Med. 2020; 9 (3): 813. DOI: 10.3390/jcm9030813
  19. 19. Yacoub R., Campbell K.N. Inhibition of RAS in diabetic nephropathy. Int J Nephrol Renovasc Dis. 2015; 8: 29–40. DOI: 10.2147/IJNRD.S37893
  20. 20. Heerspink H.J.L., Kosiborod M., Inzucchi S.E. et al. Renoprotective effects of sodium-glucose cotransporter-2 inhibitors. Kidney Int. 2018; 94 (1): 26–39. DOI: 10.1016/j.kint.2017.12.027
  21. 21. Gorriz J.L., Navarro-Gonzalez J.F., Ortiz A. et al. Sodium-glucose cotransporter 2 inhibition: towards an indication to treat diabetic kidney disease. Nephrol Dial Transplant. 2020; 35: i13–i23. DOI: 10.1093/ndt/gfz237
  22. 22. Keri K.C., Samji N.S., Blumenthal S. Diabetic nephropathy: newer therapeutic perspectives. J Community Hosp Intern Med Perspect. 2018; 8 (4): 200–7. DOI: 10.1080/20009666.2018.1500423
  23. 23. Shivakumar O., Sattar N, Wheeler D.C. Sodium-glucose cotransporter 2 inhibitor effects on cardiovascular outcomes in chronic kidney disease. Nephrol Dial Transplant. 2020; 35 (S1): i43–i47. DOI: 10.1093/ndt/gfz292
  24. 24. Sulaiman M.K. Diabetic nephropathy: recent advances in pathophysiology and challenges in dietary management. Diabetol Metab Syndr. 2019; 11: 7. DOI: 10.1186/s13098-019-0403-4
  25. 25. Gomez L.A., Lei Y., Devarapu S.K. et al. The diabetes pandemic suggests unmet needs for «CKD with diabetes» in addition to «diabetic nephropathy» – implications for pre-clinical research and drug testing. Nephrol Dial Transplant. 2018; 33 (8): 1292–304. DOI: 10.1093/ndt/gfx219
  26. 26. Smirnov A.V., Dobronravov V.A., Kisina A.A. i dr. Klinicheskie rekomendatsii po diagnostike i lecheniju diabeticheskoj nefropatii. Nefrologija. 2015; 19 (1): 67–77 [Smirnov A.V., Dobronravov V.A., Kisina A.A. et al. Clinical practice guideline for diagnostics and treatment of diabetic nephropathy. Nephrology (Saint-Petersburg). 2015; 19 (1): 67–77 (in Russ.)].
  27. 27. Bakris G.L, Agarwal R, Anker S.D. et al. Design and Baseline Characteristics of the Finerenone in Reducing Kidney Failure and Disease Progression in Diabetic Kidney Disease Trial. Am J Nephrol. 2019; 50 (5): 333–44. DOI: 10.1159/000503713
  28. 28. Anders H.-J., Davis J.M., Thurau K. Nephron Protection in Diabetic Kidney Disease. N Engl J Med. 2016; 375 (21): 2096–8. DOI: 10.1056/NEJMcibr1608564
  29. 29. Williams B., Mancia G., Spiering W. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018; 39 (33): 3021–104. DOI: 10.1093/eurheartj/ehy339
  30. 30. Bateman B.T., Patorno E., Desai R.J. et al. Angiotensin-Converting Enzyme Inhibitors and the Risk of Congenital Malformations. Obstet Gynecol. 2017; 129 (1): 174–84. DOI: 10.1097/AOG.0000000000001775
  31. 31. Bullo M., Tschumi S., Bucher B.S. et al. Pregnancy outcome following exposure to angiotensin- converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review. Hypertension. 2012; 60 (2): 444–50. DOI: 10.1161/HYPERTENSIONAHA.112.196352
  32. 32. Coutrot M., Depret F., Legrand M. Tailoring treatment of hyperkalemia. Nephrol Dial Transplant. 2019; 34 (S3): iii62–iii68. DOI: 10.1093/ndt/gfz220
  33. 33. Seliger S.L. Hyperkalemia in patients with chronic renal failure. Nephrol Dial Transplant. 2019; 34 (S3): iii12–iii18. DOI: 10.1093/ndt/gfz231
  34. 34. Hou J., Xiong W., Cao L. Spironolactone add-on for preventing or slowing the progression of diabetic nephropathy: a meta-analysis. Clin Ther. 2015; 37 (9): 2086–103. DOI: 10.1016/j.clinthera.2015.05.508
  35. 35. Bianchi S., Regolisti G. Pivotal clinical trials, meta-analyses and current guidelines in the treatment of hyperkalemia. Nephrol Dial Transplant. 2019; 34 (S1): iii51–iii61. DOI: 10.1093/ndt/gfz213
  36. 36. Hunter R.W., Bailey M.A. Hyperkalemia: pathophysiology, risk factors and consequences. Nephrol Dial Transplant. 2019; 34 (S3): iii2–iii11. DOI: 10.1093/ndt/gfz206
  37. 37. Trevisan M., de Deco P., Xu H. Incidence, predictors and clinical management of hyperkalaemia in new users of mineralocorticoid receptor antagonists. Eur J Heart Fail. 2018; 20: 1217–26. DOI: 10.1002/ejhf.1199
  38. 38. Pitt B., Bakris G.L., Weir M.R. Long-term effects of patiromer for hyperkalaemia treatment in patients with mild heart failure and diabetic nephropathy on angiotensin-converting enzymes/angiotensin receptor blockers: results from AMETHYST-DN. ESC Heart Fail. 2018; 5 (4): 592–602. DOI: 10.1002/ehf2.12292
  39. 39. Clase C.M., Carrero J.-J., Ellison D.H. et al. Potassium homeostasis and management of dyskalemia in kidney diseases: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020; 97 (1): 42–61. DOI: 10.1016/j.kint.2019.09.018
  40. 40. Liu L.C., Schutte E., Gansevoort R.T. Finerenone: third-generation mineralocorticoid receptor antagonist for the treatment of heart failure and diabetic kidney disease. Expert Opin Investig Drugs. 2015; 24 (8): 1123–35. DOI: 10.1517/13543784.2015.1059819