Title Novosti u liječenju kronične bubrežne bolesti Title (english) Novelties in the treatment of chronic kidney disease Author Marija Hanžić Mentor Sandra Karanović Štambuk (mentor)Committee member Živka Dika (predsjednik povjerenstva)Committee member Ivana Vuković Brinar (član povjerenstva)Committee member Sandra Karanović Štambuk (član povjerenstva)Granter University of Zagreb Defense date and country 2023-07-13, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Kronična bubrežna bolest (KBB) predstavlja oštećenje bubrežne strukture ili funkcije prisutno dulje od 3 mjeseca. Globalna prevalencija KBB je sve veća, a smatra se kako će do 2040. godine ona biti 5. vodeći uzrok mortaliteta u svijetu. Takva očekivanja povezana su s porastom prevalencije šećerne bolesti tip 2 i arterijske hipertenzije – dvama vodećim uzrocima KBB. KBB dijelimo u 5 stadija od kojih je zadnji stadij terminalni, bubrežno zatajenje. Tada je nužno pristupiti nadomjesnom liječenju: dijalizi ili transplantaciji bubrega kao optimalnom rješenju. Reputacija KBB kao „tihog ubojice“ potkrijepljena je činjenicom kako se prvi simptomi obično pojavljuju tek u uznapredovalim fazama bolesti. Brojne komplikacije su posljedica KBB: poremećaji mineralokoštanog metabolizma, anemija, hiperkalemija, a najznačajnije i najopasnije komplikacije tiču se kardiovaskularnog sustava. Terapija KBB orijentirana je na usporavanje progresije bolesti, liječenje komplikacija i djelovanje na rizične čimbenike koji pogoršavaju kliničke ishode. Dosad su se koristili blokatori renin-angiotenzinskog sustava za regulaciju arterijske hipertenzije i kupiranje proteinurije, savjetovala promjena životnih navika poput prestanka pušenja, prilagodbe u prehrani, smanjenje tjelesne težine u pacijenata s pretilošću i izbjegavanje sedentarnog načina života, regulirala hiperglikemija u dijabetičara te izbjegavalo daljnje bubrežno oštećenje. Složenost u liječenju KBB očituje se u činjenici da je u terapiji potrebno istovremeno djelovanje na više čimbenika što iziskuje i dobro poznavanje patofiziologije KBB. Zabrinjavajuće spoznaje o porastu prevalencije i mortaliteta KBB te relativno uskom okviru od pojave prvih simptoma do bubrežnog zatajenja ponukale su medicinske stručnjake na intenzivnija istraživanja novijih mogućnosti u liječenju KBB. Sve je veća pojava novih dokaza o kvaliteti lijekova poput SGLT2 inhibitora, GLP- 1 agonista, te novih antagonista mineralokortikoidnih receptora koji poboljšavaju kardiovaskularne i renalne ishode. Isto tako, pojava novih vezača kalija pruža novu mogućnost u liječenju hiperkalemije. Ovaj rad predstavlja nove spoznaje, ali pruža i osvrt na dosadašnja iskustva i saznanja o liječenju KBB.
Abstract (english) Chronic kidney disease (CKD) is defined as a structural or functional renal impairment lasting more than 3 months. The global prevalence of CKD is increasing, and it is predicted to become the 5th leading cause of mortality in the world by the year 2040. Such expectations are in line with the increased prevalence of type 2 diabetes and arterial hypertension - two leading causes of CKD. CKD can be classified into five stages, based on the assessment of glomerular filtration rate, with the last stage being renal failure. At this point, renal replacement therapy becomes necessary. The reputation of CKD as a "silent killer" is supported by the fact that the first symptoms usually appear only in the advanced stages of the disease. Numerous complications are the result of CKD, including disorders of bone and mineral metabolism, anemia, hyperkalemia, as well as the most significant and dangerous complications related to the cardiovascular system. CKD therapy is focused on slowing the progression of the disease, treating complications and reducing risk factors that worsen clinical outcomes. Until recently, CKD treatment has been directed at renin-angiotensin system inhibitors, lifestyle changes such as smoking cessation, adjusting dietary habits, reducing weight in obese patients and avoiding sedentary lifestyle, regulating hyperglycemia in diabetic patients and avoiding further kidney damage. The complexity of CKD treatment is evident from the fact that simultaneous action is required to address several factors, which requires a good understanding of CKD pathophysiology. Disturbing findings related to the increase in CKD prevalence and mortality, as well as the relatively narrow timeframe from the onset of symptoms to kidney failure, have encouraged medical professionals to search for new possibilities in CKD treatment. There is an increasing amount of evidence about the effectivenes of SGLT2 inhibitors, GLP-1 agonists, and novel mineralocorticoid receptor antagonists in improving cardiovascular and renal outcomes in CKD patients. The emergence of new potassium binders provides a new opportunity in treatment of hyperkalemia. This paper presents new findings, but also provides an overview of previous experiences and knowledge related to CKD treatment.
Keywords
finerenon
GLP-1 agonisti
kronična bubrežna bolest
patiromer
SGLT2 inhibitori
Keywords (english)
chronic kidney disease
finerenone
GLP-1 agonists
patiromer
SGLT2 inhibitors
Language croatian URN:NBN urn:nbn:hr:105:986465 Study programme Title: Medicine Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2023-10-24 11:20:42
