Журнал "Почки" том 7, №1 (2018г.)

Настанови / Guidelines
1 2 3 4 5 6 7 8 9 10 11
High Oral Neutral — Renal
dose
adjustment
required; cam
be used in
renal impairment
Low Oral Neutral — Notdose
adjustment
required
— Generallly
not recommended
in
renal impairment
due to
potential for
fluid retention
Thiazolidinediones
Sulfonylureas
(2 nd generation)
Insulin
DPP-4 Inhibitors
Intermediate
Benefit:
liraglutide
No Neutral Neutral Potential
risic
saxagliptin,
alogliptin
High No Gain Potential
benefit:
pioglitazone
In creased
risk
High Yes Gain Neutral Neutral
— FDA Special
Warning on increased
risk of
cardiovascular
mortality based
on studies of an
older sulfonylurea
(tolbutamide)
— Higher risk of
hypoglycemia
with human
insulin (NPH
or premixed
formulations) vs
analogs
Human
insulin
Analogs
Highest
Yes Gain Neutral Neutral
Low Oral Neutral — Glyburide:
not recommended
— Glipizide
& glimepiride
initiate conservatively
to
avoid hypoglycemia
Low SQ Neutral — Lower
insulin doses
required with
a decrease in
High
SQ
eGFR; titrate
per clinical
response
Table 8.1
— Injection site
reactions
— Acute pancreatitis
risk
— Potential
risk of acute
pancreatitis
— Joint pain
— FDA Black
Box: congestive
heart failure
(pioglitazone,
rosiglitazone)
— Fluid retention
(edema;
heart failure)
— Benefit in
NASH
— Risk of bone
fractures
— Bladder
cancer (pioglitazone)
— ↑ LDL cholesterol
(rosiglitazone)
— Для пациентов с диабетом 2-го типа, которые не
достигают целевой гликемии, не следует откладывать интенсификацию
лечения, включая рассмотрение терапии
инсулином (В).
— Метформин следует продолжать в сочетании с другими
препаратами, включая инсулин, если он не противопоказан
и хорошо переносим.
9. Сердечно-сосудистые заболевания
и управление рисками
Гипертензия/контроль артериального давления
Рекомендации
Скрининг и диагностика
— Артериальное давление следует измерять при каждом
регулярном клиническом визите. У пациентов с повышенным
кровяным давлением (≥ 140/90 мм рт.ст.) оно
— For patients with type 2 diabetes who are
not achieving glycemic goals, drug intensification,
including consideration of insulin therapy, should
not be delayed (B).
— Metformin should be continued when used
in combination with other agents, including insulin,
if not contraindicated and if tolerated (A).
9. Cardiovascular disease and risk
management
Hypertension/blood pressure control
Recommendations
Screening and diagnosis
— Blood pressure should be measured at every
routine clinical visit. Patients found to have
elevated blood pressure (≥ 140/90) should have
Vol. 7, No. 1, 2018
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