Ингибиторы натрий-глюкозного котранспортера 2-го типа: новый класс лекарственных средств для лечения диабетической и недиабетической нефропатии

Ингибиторы почечного натрий-глюкозного котранспортера 2-го типа (SGLT2) являются новым классом противодиабетических средств, которые недавно внедрены в клиническую практику для лечения больных СД 2-го типа. По данным исследования CREDENCE, включение канаглифлозина в лекарственную терапию пациентов с СД 2-го типа не только обеспечивает адекватный контроль уровня глюкозы в крови, но и оказывает выраженный нефропротективный эффект, который проявляется в значительном снижении риска прогрессирования нарушения функции почек у лиц с С2, С3а и С3б стадиями ХБП. Выявление у ингибиторов SGLT2 нефропротективного действия, не зависящего от их антигипергликемического эффекта, предполагает возможность применения препаратов этого класса для медикаментозной терапии пациентов с ХБП недиабетической этиологии. В обзоре представлены данные клинических исследований, посвященных выяснению участия диуретического эффекта и связанного с ним снижения АД и венозного застоя в почках, улучшения гломерулярной гемодинамики и угнетения активности внутрипочечной РАС в механизме нефропротективного действия этих препаратов. В настоящее время проводятся крупномасштабные исследования DAPA-CKD и EMPA-KIDNEY, результаты которых позволят получить сведения о клинической эффективности и безопасности применения дапаглифлозина и эмпаглифлозина у недиабетических больных с нарушением функции почек разной степени тяжести, включая лиц с С4 стадией ХБП. Первоначальные данные, полученные в исследовании DAPA-CKD, свидетельствуют о том, что дапаглифлозин при добавлении к нефропротективной терапии значительно улучшает почечные исходы не только у больных с СД 2-го типа, но и пациентов с ХБП недиабетического происхождения, включая лиц с гломерулонефритом, гипертонической нефропатией и другими поражениями почек.

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