Glucagon-like peptide 1(GLP-1) receptor agonists in the management of the patient with type 2diabetes mellitus and chronic kidney disease: an approach for the nephrologist.

Diabetic kidney disease, a common complication in patients with type 2 diabetes mellitus, is associated with a markedly increased morbidity and mortality, especially of cardiovascular origin, and faster progression to end-stage renal disease. To date, reducing cardiovascular and renal risk in this population was based on strict control of cardiovascular risk factors and the renin-angiotensin system blockade. More recently, sodium-glucose cotransporter type 2 inhibitors have demonstrated to offer cardiovascular and renal protection, but the residual risk remains high and their antihyperglycemic efficacy is limited in moderate-severe CKD. Therefore, drugs with a potent antihyperglycemic effect, independent of the glomerular filtration rate, with a low risk of hypoglycemia, that reduce weight in overweight/obese patients and that provide cardiovascular and renal protection, such as GLP-1 receptor agonists, are needed. However, these drugs require subcutaneous administration, which may limit their early use. The recent availability of oral semaglutide may facilitate the early introduction of this family with proven cardiovascular and renal benefits and excellent safety profile. In this review the family is analyzed as well as their cardiovascular and renal effects.

Agonistas del receptor de péptido similar al glucagón tipo 1 (GLP-1) en el manejo del paciente con diabetes mellitus tipo 2. Una aproximación para el nefrólogo / Glucagon-like peptide 1(GLP-1) receptor agonists in the management of the patient with type 2diabetes mellitus and chronic kidney disease: An approach for the nephrologist

La enfermedad renal diabética, frecuente en pacientes con diabetes mellitus tipo 2, se asocia con un marcado incremento de la morbimortalidad, especialmente cardiovascular, y de progresión a enfermedad renal crónica terminal. Hasta la fecha la reducción del riesgo cardiovascular y renal en esta población se ha basado en el control estricto de los factores de riesgo cardiovascular y en el uso de inhibidores del sistema renina-angiotensina. Mas recientemente los inhibidores del cotransportador sodio-glucosa tipo 2 han demostrado ofrecer protección cardiovascular y renal, pero el riesgo residual sigue siendo alto y su eficacia antihiperglucemiante es limitada en ERC moderada-severa. Por ello se precisan fármacos con un potente efecto antihiperglucemiante, independiente del filtrado glomerular, con bajo riesgo de hipoglicemia, que reduzcan el peso en pacientes con sobrepeso/obesidad y que proporcionen una protección cardiovascular y renal, como los agonistas del receptor de GLP-1. Sin embargo, estos fármacos precisan de su administración subcutánea, lo que puede limitar su uso temprano. La reciente disponibilidad de semaglutida oral puede ayudar a la introducción precoz de esta familia con beneficios cardiovasculares y renales probados y excelente perfil de seguridad. En esta revisión se describe la familia y sus efectos cardiovasculares y renales. (AU)

Diabetic kidney disease, a common complication in patients with type 2 diabetes mellitus, is associated with a markedly increased morbidity and mortality, especially of cardiovascular origin, and faster progression to end-stage renal disease. To date, reducing cardiovascular and renal risk in this population was based on strict control of cardiovascular risk factors and the renin–angiotensin system blockade. More recently, sodium-glucose cotransporter type 2 inhibitors have demonstrated to offer cardiovascular and renal protection, but the residual risk remains high and their antihyperglycemic efficacy is limited in moderate-severe CKD. Therefore, drugs with a potent antihyperglycemic effect, independent of the glomerular filtration rate, with a low risk of hypoglycemia, that reduce weight in overweight/obese patients and that provide cardiovascular and renal protection, such as GLP-1 receptor agonists, are needed. However, these drugs require subcutaneous administration, which may limit their early use. The recent availability of oral semaglutide may facilitate the early introduction of this family with proven cardiovascular and renal benefits and excellent safety profile. In this review the family is analyzed as well as their cardiovascular and renal effects. (AU)

¿Debemos manejar la hiperuricemia asintomática para proteger al riñón?

Contexto: el ácido úrico es el producto final de la degradación de las purinas en los primates, en condiciones normales es un agente antioxidante endógeno y participa en varias vías fisiológicas, sin embargo, cuando los niveles séricos de urato se incrementan, estos participan en el desarrollo de diversas enfermedades. Desde el siglo XIX se conoce de la asociación entre hiperuricemia y daño renal, aunque ninguna guía de manejo recomienda el uso de fármacos hipouricemiantes en pacientes asintomáticos, en algunos casos especiales, el manejo farmacológico beneficiará a pacientes con hiperuricemia, brindando protección al riñón y disminuyendo el riesgo de desarrollar enfermedad renal terminal. Objetivo: describir la relación entre hiperuricemia y daño renal, y analizar los casos en los que el manejo de esta condición con medicamentos resultará en un beneficio para el riñón de los pacientes. Metodología: revisión de la literatura sobre la participación de la hiperuricemia en el daño renal y análisis de los artículos revisados. Resultados: el manejo de la hiperuricemia asintomática puede proteger el riñón en algunas situaciones específicas. Conclusiones: hay situaciones específicas para la disminución de los niveles séricos de ácido úrico.

Background: Uric acid is the end product of purine degradation in primates, under normal conditions it is an endogenous antioxidant agent and participates in several physiological pathways. However, when serum urate levels are increased, they participate in the development of various diseases. Since the nineteenth century, the association between hyperuricemia and kidney damage has been known. Although no management guideline recommends the use of hypouricemic drugs in asymptomatic patients, in some special cases pharmacological management will benefit patients with hyperuricemia, providing protection to the kidney and decreasing the risk of developing end-stage renal disease. Purpose: To describe the relationship between hyperuricemia and kidney damage, and to analyze the cases in which the management of this condition with medications will result in a benefit for the kidney of patients. Methodology: Review of the literature on the involvement of hyperuricemia in kidney damage, analysis of the reviewed articles. Results: Management of asymptomatic hyperuricemia may protect the kidney in some specific situations. Conclusions: There are specific situations for the decrease of serum uric acid levels.

Sodium-Glucose Co-Transporter Type 2 Inhibitors and Heart Failure: A Review of the State of the Art / Inhibidores del Cotransportador de Sodio-Glucosa Tipo 2 e Insuficiencia Cardíaca: Una Revisión del Estado del Arte

Heart Failure (HF) is a cardiovascular condition with high morbidity and mortality that conditions one of the most critical problems in public health. Despite advances in recent decades, patients continue to have major cardiovascular events and marked reduction in their quality of life. Sodium-Glucose Cotransporter Type 2 Inhibitors (SGLT2 Inhibitors) initially entered the market to treat hyperglycemia in patients with type 2 diabetes mellitus (T2DM), however the discovery of the cardiovascular benefits in patients with HF, regardless of the presence or absence of T2DM positioned it as a new pillar in clinical management.In this state-of-the-art review resulting from a comprehensive literature search (Medline, Cochrane and EMBASE), we describe the impact of SGLT2 Inhibitors on mortality and rehospitalizations in patients with HF and we propose a therapeutic plan for patients with HF to maximizes the benefits. (AU)

La Insuficiencia Cardíaca (IC) es una condición cardiovascular con alta morbilidad y mortalidad que condiciona uno de los problemas más críticos en salud pública. A pesar de los avances en las últimas décadas, los pacientes continúan presentando eventos cardiovasculares importantes y una marcada reducción de su calidad de vida. Los inhibidores del cotransportador de sodio-glucosa tipo 2 (SGLT2) ingresaron inicialmente al mercado para tratar la hiperglucemia en pacientes con diabetes mellitus tipo 2 (DMT2), sin embargo, el descubrimiento de los beneficios cardiovasculares en pacientes con IC, independientemente de la presencia o ausencia de DMT2, lo posicionó como un nuevo pilar en manejo clínico.Esta revisión de la literatura es resultante de una búsqueda bibliográfica exhaustiva (Medline, Cochrane y EMBASE), y describimos el impacto de los iSGLT2 en la mortalidad y rehospitalizaciones en pacientes con IC y proponemos un plan terapéutico para pacientes con IC para maximizar los beneficios. (AU)

Revisión sistemática sobre nuevas estrategias en la prevención de la Nefropatía Inducida por Contrastes / Systematic review of new strategies in the prevention of Contrast-Induced Nephropathy

La Nefropatía Inducida por Contrastes (NIC) es unapatología de elevada incidencia, asociada a la administración demedios de contraste. A pesar de los esfuerzos enfocados en prevenirsu desarrollo mediante actuaciones como la reducción del volumendel medio de contraste administrado, el uso de contrastes menostóxicos y la valoración previa de los factores de riesgo, esta patologíasigue siendo la tercera causa mundial de fallo renal agudo. Esto haceque sea imprescindible establecer un abordaje preventivo. En estetrabajo se han valorado las estrategias de prevención frente a la NICque se han evaluado en los últimos 10 años. La mayor parte de losestudios proponen la hidratación en combinación con antioxidantes,sin embargo, los resultados obtenidos no han sido concluyentes.Estrategias mas actuales como la administración de trimetazidina, unfármaco anti-isquémico; el tratamiento con el hongo Cordycepssinensis, con demostradas propiedades renoprotectoras; el oxígenopor vía inhalatoria; o las terapias basadas en el preacondicionamiento isquémico han resultado ser más eficaces en laprevención de la NIC, pero necesitan ser consolidadas con unaevidencia sólida y posiblemente adaptarse y orientarse de maneraindividual, en función de los factores de riesgo asociados a cadapaciente (AU)

Contrast-Induced Nephropathy (CIN) is a high-incidence pathologyassociated with the administration of contrast media. Despite effortsfocused on preventing its development through actions such asreducing the volume of the contrast medium administered, the use ofless toxic contrasts and the prior assessment of risk factors, thispathology continues to be the third world cause of acute kidneyfailure. This makes it essential to establish a preventive approach. Inthis work, prevention strategies for CIN studied in the last 10 yearshave been evaluated. Most of the studies propose hydration incombination with antioxidants, however, the results obtained havenot been conclusive. More current strategies such as theadministration of trimetazidine, an anti-ischemic drug; treatment withthe Cordyceps sinensis fungus, with proven renoprotectiveproperties; inhalational oxygen; or therapies based on ischemic preconditioning have proven to be more effective in the prevention ofCIN, but they need to be consolidated with solid evidence andpossibly adapted and oriented individually, depending on the riskfactors associated with each patient (AU)

Adherencia farmacológica de pacientes con diabetes mellitus en un programa de nefroprotección: una responsabilidad compartida / Medication adherence of patients with diabetes mellitus in a nephroprevention program: a shared responsibility

Resumen Introducción: la diabetes mellitus tipo dos es una enfermedad crónica de gran impacto en salud pública; su mal control clínico está supeditado a la deficiente adherencia farmacológica. Los programas de nefroprotección intentan mejorar el control de esta enfermedad y una adecuada adherencia puede ser una estrategia. El objetivo del estudio fue determinar los factores asociados con la adherencia farmacológica de pacientes con diabetes en el contexto de un programa de nefroprotección. Materiales y métodos: estudio transversal analítico en 282 pacientes con diabetes mellitus tipo dos de un programa de nefroprotección en los municipios de Pasto y Túquerres en el año 2017, seleccionados mediante muestreo aleatorio, sistemático estratificado. La adherencia se midió con el test Morisky-Green. La información se obtuvo de bases de datos de las historias clínicas y mediante un cuestionario estructurado. Se efectuaron análisis descriptivo, bivariado y regresión logística binaria multivariada con fines explicativos. Las medidas de asociación fueron razones de prevalencia (RP). Resultados: la mediana de la edad fue de 67 años, 33 % fueron hombres y la proporción de adherencia del 68 %; los factores que se asociaron independientemente fueron, ser mujer RP: 1,25 (IC 95 %: 1,02-4,07), hemoglobina glicosilada entre 6 y 6,9 % RP: 1,66 (1,37-11,80), no uso de insulina RP: 1,36 (1,03-8,52), empleo de solo metformina RP: 1,76 (1,76-10,15) y consulta por medicina interna RP: 1,19 (1,19-4,78). Conclusión: la adherencia farmacológica está influenciada por múltiples factores que no sólo dependen del paciente, sino que involucran también a los profesionales de salud, el tipo de medicación y su disponibilidad, además de asociarse con el control glucémico.

Abstract Introduction: The type two diabetes is a chronic disease of great impact on public health. Its deficient clinical control is subject to poor medication adherence. Nephroprevention programs seek to improve the contro of this disease and an adequate adherence may be a strategy. The aim of this study was to determine the factors associated with medication adherence in patients with diabetes in the context of a nephroprevention program. Materials and methods: A cross-sectional study was conducted among 282 patients with type two diabetes mellitus from a nephroprevention program in the municipalities of Pasto and Túquerres in 2017; they were selected by a systematic stratified random sampling. The Morisky-Green test assessed adherence. Information was obtained from databases, medical records and through a structured questionnaire. A descriptive, bivariate analysis and a multivariate binary logistic regression for explanatory purposes were performed. The association measures were prevalence ratios (PR). Results: The median age of the participants was 67 years, 33 % were men and the proportion of adherence was 68 %. Factors that were independently associated with adherence were being a wo- man, PR: 1,25 (95% CI: 1,02-4,07), glycosylated hemoglobin between 6 %-6,9 %, PR: 1,66 (1,37-11,80), not using insulin PR: 1,36 (1,03-8,52), use of only metformin PR: 1,76 (1,76-10,15) and consultation by internal medicine, PR: 1,19 (1,19-4,78). Conclusion: The adherence to medication is influenced by multiple factors which not only depend on the patient, but also involve health professionals, the type of medication and its availability, as well as being associated with glycemic control

Melatonin ameliorates the drug induced nephrotoxicity: Molecular insights.

BACKGROUND: Drug-induced nephrotoxicity is a frequent adverse event that can lead to acute or chronic kidney disease and increase the healthcare expenditure. It has high morbidity and mortality incidence in 40-70% of renal injuries and accounts for 66% cases of renal failure in elderly population. OBJECTIVE: Amelioration of drug-induced nephrotoxicity has been long soughed to improve the effectiveness of therapeutic drugs. This study was conducted to review the melatonin potential to prevent the pathogenesis of nephrotoxicity induced by important nephrotoxic drugs. METHODS: We analyzed the relevant studies indexed in Pubmed, Medline, Scielo and Web of science to explain the molecular improvements following melatonin co-administration with special attention to oxidative stress, inflammation and apoptosis as key players of drug-induced nephrotoxicity. RESULTS: A robust consensus among researchers of these studies suggested that melatonin efficiently eradicate the chain reaction of free radical production and induced the endogenous antioxidant enzymes which attenuate the lipid peroxidation of cellular membranes and subcellular oxidative stress in drug-induced nephrotoxicity. This agreement was further supported by the melatonin role in disintegration of inflammatory process through inhibition of principle pro-inflammatory or apoptotic cytokines such as TNF-α and NF-κB. These studies highlighted that alleviation of drug-induced renal toxicity is a function of melatonin potential to down regulate the cellular inflammatory and oxidative injury process and to stimulate the cellular repair or defensive mechanisms. CONCLUSION: The comprehensive nephroprotection and safer profile suggests the melatonin to be a useful adjunct to improve the safety of nephrotoxic drugs.

The administration of contrast media: is there a risk of acute kidney injury? / Administración de medios de contraste. ¿Existe riesgo de daño renal agudo?

OBJECTIVE: To determine whether the intravenous administration of iodinated contrast material for computed tomography (CT) is associated with an increase in creatinine levels and acute kidney injury. MATERIAL AND METHODS: This retrospective cohort study included all patients who presented at the emergency department between 2010 and 2015 with baseline creatinine measurement (C1) and follow-up creatinine measurement (C2) between 24 and 72hours later. The clinical research ethics committee approved the study. The exclusion criteria were age <18 years, creatinine ≤ 0.4mg/dl or ≥4.0mg/dl, and the administration of contrast media within the previous 6 months. The mean number of patients presenting at the emergency department was 105,435.6 per year. Patients who met the inclusion criteria were classified into three groups: those who underwent contrast-enhanced CT (n=6,642), those who underwent noncontrast CT (n=6,193), and those who did not undergo CT (n=33,802). We used the Acute Kidney Injury Network's (AKIN) and the Contrast-induced Nephropathy Consensus Working Panel's (CIN) criteria. Statistical analyses included bivariate statistics and logistic regression. Stata 15 was used for all statistical analyses. RESULTS: We analyzed 52,411 patients; after data cleansing: 46,637; mean age: 67.95 years; C1: mean 1.16mg/dl (SD: 0.61); C2: 1.14mg/dl (SD: 0.66). With AKIN and CIN criteria: contrast-enhanced CT was not associated with a greater probability of developing nephropathy (odds ratio [OR: 0.90; 95% CI: 0.83-0.99] and [OR 0.89, 95% CI: 0.81-0.98], respectively). The propensity score matching study using both sets of criteria (AKIN+CIN) yielded OR 0.80 [95% CI: 0.77-0.84]. Glomerular filtration rates less than 30ml/min were not associated with increased kidney damage [OR: 0.66, 95% CI: 0.47-0.91]. CONCLUSION: The administration of intravenous contrast material in the patients studied is not associated with increased acute kidney injury.

Spanish Diabetes Society (SED) recommendations for the pharmacologic treatment of hyperglycemia in type 2 diabetes: 2018 Update. / Recomendaciones de la Sociedad Española de Diabetes (SED) para el tratamiento farmacológico de la hiperglucemia en la diabetes tipo 2: Actualización 2018.

Type 2 diabetes mellitus (DM2) has become a problem of global dimensions by their high and growing prevalence worldwide and the personal and economic costs associated with it. Correct treatment can reduce mortality and associated complications. New concepts have recently been included in routine clinical practice and have changed the algorithm of DM2 pharmacological therapy. Therefore, the Spanish Society of Diabetes (SED) entrusted to the Working Group of Consensus and Clinical Guidelines an update of the 2010 document Recommendations for Pharmacological Treatment of Hyperglycemia in Diabetes type2. Novel aspects include nine characteristics to describe each drug group: efficiency, the risk of hypoglycemia, effects on body weight, the demonstrated effect in cardiovascular risk, nephroprotection, limitation of use in renal insufficiency, the rate of secondary effects, complexity and costs. Additionally, the document details combination options, and develop the start and adjustment of available injectable therapies.

Metformin in kidney diabetic disease: Current state / Metformina en enfermedad renal diabética: estado actual

Abstract Current therapy directed at delaying the progression of diabetic renal disease includes intensive glycemic and optimal blood pressure control, renin angiotensin-aldosterone system blockade and multifactorial intervention. However, the renal protection provided by these therapeutic modalities is not complete. There is a scarcity of studies analyzing the nephroprotective effect of antihyperglycemic drugs beyond their glucose lowering effect and progression of diabetic renal disease. This article updates the existing data about metformin in diabetic kidney disease.

Resumen El tratamiento actual dirigido a retardar la progresión de la enfermedad renal diabética incluye el control intensivo de la glucemia, con control óptimo de la hipertensión arterial y bloqueo del sistema renina-angiotensina-aldosterona, junto con otras intervenciones multifactoriales. Sin embargo, a pesar de estas medidas, la protección renal no se alcanza en su totalidad. Hay escasos estudios que analizan el efecto nefroprotector de las drogas antihiperglucemiantes, más allá de su efecto hipoglucemiante. Este artículo analiza la información existente sobre el estatus actual de la metformina en la enfermedad renal diabética.

iSGLT2 y su potencial efecto nefroprotector en pacientes con diabetes mellitus 2 / iSGLT2 and its potential nephroprotector effect in patients with diabetes mellitus 2

Resumen: La diabetes mellitus 2 es una epidemia mundial, aunado a esto, la nefropatía diabética se ha convertido en la principal causa de insuficiencia renal en etapa terminal. En los pacientes con diabetes mellitus 2 existe sobreexpresión de los cotransportadores de glucosa ligados a la vía del sodio tipo 2 (SGLT2) que contribuyen al mantenimiento de la hiperglucemia. Por tanto, los inhibidores de este transportador representan un tratamiento innovador independiente de la acción de la insulina o la función de las células beta pancreáticas. En estudios recientes se ha demostrado que los iSGLT2 tienen efectos benéficos en la microvasculatura, en especial en la progresión de la nefropatía diabética. Este efecto no sólo se debe a la mejora del control glucémico, sino también a efectos directos en el riñón. Los iSGLT2, al inducir la glucosuria, revierten la glucotoxicidad renal. En estudios experimentales se ha observado que, además, se reduce la hiperfiltración, así como los marcadores inflamatorios y fibróticos. También se ha visto reducción del volumen circulante efectivo y aumento en la actividad de bloqueadores del sistema renina-angiotensina-aldosterona (bloqueadores RAA) circulantes, creando así un efecto nefroprotector.

Abstract: Type 2 diabetes mellitus 2 (DM2) is already a worldwide epidemic, in addition, diabetic nephropathy has become the leading cause of end-stage renal failure. In patients with DM2 there is an increased expression of the sodium-glucose cotransporters 2 (SGLT2) that contribute to the maintenance of hyperglycemia. Therefore, the inhibitors of this transporter represent an innovative therapy independent of the action of insulin or the function of pancreatic beta cells. Recent studies have shown that iSGLT2 have beneficial effects on microvasculature, especially in the progression of diabetic nephropathy. This effect is due not only to improved glycemic control but also to direct effects on the kidney. iSGLT2 induce glycosuria to reverse renal glucotoxicity. In experimental studies it has been observed that, in addition, hyper-filtration as well as inflammatory and fibrotic markers are reduced. There has also been a reduction in effective circulating volume and an increase in the activity of circulating renin-angiotensin-aldosterone system blockers (RAA blockers), thus creating a nephroprotective effect.

How useful in the daily practice of nephrologists are the new antidiabetics with cadiovascular protection? / ¿Qué tan útiles en la práctica diaria para los nefrólogos son los nuevos antidiabéticos con protección cardiovascular?

Abstract In recent years, several new antidiabetic drugs have been developed, among which only two have demonstrated superiority in cardiovascular protection. They are liraglutide and empagliflozine, which belong, respectively, to GLP-1 RA and SGLT-2Í. These medications have also shown benefits in kidney protection. However, in a recent survey of the author among nephrologists in a large colombian city, it has been detected that most do not use these drugs. The greater resistance to the limitation in its use is due to the advanced stages of chronic kidney disease where they are contraindicated, but also to the anawareness of their potential benefits. In this regard, the nephrologists accepted they should learn more about these antidiabetic medicines, because the type of patient that is frequently attended in their consultation will undoubtly benefit, and considering they are obligated to handle the diabetic patient directly.

Resumen En los últimos años se han desarrollado nuevos fármacos antidiabéticos, entre los que sólo dos han demostrado superioridad en protección cardiovascular. Son liraglutida y empagliflozina, que pertenecen, respectivamente, a los grupos GLP-1 RA y SGLT-2Í. Estos medicamentos también han demostrado beneficios en nefroprotección. Sin embargo, en una reciente encuesta del autor entre nefrólogos, en una gran ciudad colombiana, se ha detectado que la mayoría no utilizan estos fármacos. La mayor resistencia a su uso se debe a consideraciones sobre su restricción en etapas avanzadas de la enfermedad renal crónica, pero también al desconocimiento de sus beneficios potenciales. Al respecto, los nefrólogos aceptaron que deberían aprender más acerca de estos medicamentos antidiabéticos, porque el tipo de paciente que frecuentemente asiste a su consulta sin duda se beneficiaría, y más teniendo en cuenta que por el gran número de diabéticos los nefrólogos están obligados a manejar directamente al paciente con esta patología.

Efectos renales y nefroprotección inducidos por el inhibidor del SGLT2 Empagliflozina en pacientes con diabetes mellitus: revisión de la literatura / Renal effects and nephroprotection induced by SGLT2 inhibitor Empagliflozin in patients with Diabetes Mellitus: a literature review

La insuficiencia renal es una comorbilidad frecuente en pacientes con diabetes mellitus (DM) e incrementa en ellos el riesgo cardiovascular; la hiperglucemia crónica en pacientes con DM induce una gran cantidad de alteraciones directas e indirectas en la estructura y la función renal, y constituye el principal factor para el desarrollo de la nefropatía diabética y la enfermedad renal terminal. En la presente revisión, se exponen los resultados de los estudios en los que se ha demostrado la alta tolerabilidad de empagliflozina en pacientes diabéticos con insuficiencia renal concomitante en estadios I a III. Empagliflozina, mediante la inhibición de SGLT2, ofrece una terapia novedosa con efectos benéficos no sólo sobre el control glucémico, sino también beneficios cardiovasculares y renales, los cuales han sido demostrados en el estudio EMPA-REG OUTCOME y continúan en evaluación en otros estudios

Chronic kidney disease is a frequent comorbidity in patients with diabetes mellitus (DM) and it increases their cardiovascular risk; chronic hyperglycemia in patients with DM leads to direct and indirect disorders in kidney's structure and function, and it is the principal risk factor for the development of diabetic nephropathy and end-stage renal disease. In the current review, results of studies are exposed in which high tolerability of empagliflozin is exposed in diabetic patients with kidney disease. Empagliflozin by inhibiting SGLT2 provides a novel therapy with benefic effects, not only in glycemic control, but it also has cardiovascular and renal benefits, which they have been demonstrated in the EMPA-REG OUTCOME trial, and continue in evaluation in other studies

Los antagonistas de los receptores de la angiotensina II a la luz de los estudios de mayor impacto / Los antagonistas de los receptores de la angiotensina II a la luz de los estudios de mayor impacto

Introducción: Los antagonistas de los receptores de la angiotensina II constituyen un grupo reciente de fármacos para el tratamiento de la hipertensión arterial (HTA), su utilidad se ha extendido además al manejo de la Insuficiencia cardiaca, la nefroproteccion y el infarto agudo de miocardio. Farmacología: Actúan sobre el sistema renina-angiotensina-aldosterona aunque de diferente forma, bloqueando la unión de la angiotensina II a los receptores tipo 1 de la angiotensina II presentes en numerosos tejidos (tejido muscular liso, glándula adrenal y miocardio) y, como consecuencia, inhiben su efecto vasopresor y liberador de aldosterona. Conclusiones: En la hipertensión arterial. Son la alternativa a los inhibidores de la enzima conversora de la angiotensina (IECA) cuando sea necesario utilizar un antihipertensivo del eje renina-angiotensina y el paciente no pueda o no deba utilizar un fármaco de dicho subgrupo. Como nefroprotectores. Si bien los Antagonistas de los receptores de la Angiotensina (ARA II) han disminuido los niveles de proteinuria en pacientes renales siguen siendo una alternativa a los IECA. En la insuficiencia cardiaca. Los IECA son el tratamiento inicial, mientras que los ARA II pueden ser útiles en pacientes que no los toleren. En el post infarto agudo de miocardio. Los IECA siguen siendo el tratamiento de elección y los ARA II la alternativa cuando el paciente no tolere los IECA.

Introduction: Angiotensin-receptor blockers constitute a recent group of medicaments for the treatment in hypertension, its usefulness has spread in addition to the managing of the cardiac Insufficiency, renal protection and acute myocardial infarction. Pharmacology: Alter renin-angiotensin-aldosterone system though of different form, blocking the unión of angiotensin II to its receptors (type 1) in numerous organs (muscle, adrenal gland and myocardium) and, its consequence, disable its vasopresor effect and aldosterone liberating. Conclusions: In hypertension. Angiotensin-receptor blockers are alternative to angiotensine-converting-enzime inhibitors when it is necessary to use these antihypertensives and the patient could not or should not use a medicament of the above mentioned subgroup. In renal protection. Though Angiotensin-receptor blockers have diminished the levels of proteinuria in renalpatients continued being an alternative to angiotensine-converting-enzime inhibitors. In cardiac insufficiency. Angiotensine-converting-enzime inhibitors are initial treatment, whereas Angiotensin-receptor blockers can be usefulin patients who do not tolerate them. In post-acute myocardial infarction. Angiotensine-converting-enzime inhibitors continued being treatment of choice and the alternative when patients do not tolerate these medicaments.