末期腎病變糖尿病的口服降血糖藥治療

10.6666/ClinMed.201804_81(4).0039

蔡亨政；唐德成；歐朔銘

末期腎病變(End-stage renal disease) ； 口服降血糖藥(Oral anti-diabetic agents) ； 血液透析(Hemodialysis) ； 腹膜透析(Peritoneal dialysis)

臨床醫學月刊

81卷4期（2018 / 04 / 27）

223 - 230

繁體中文

近十五年來對於各種治療糖尿病的藥物有很多的進步。然而這些新藥對於有糖尿病併發末期腎病變的病人的角色並不明確，甚至相對於沒有末期腎臟病的病人來說到底是有益處還是傷害也不確定。原因是在末期腎病變的病人血糖恆定的調節有所改變，造成病人有很高的風險發生高血糖或低血糖的情形。此外對於末期腎病變的病人來說，嚴格血糖控制對於之後的小血管及大血管病變是否有益，目前都缺乏足夠的證據。末期腎臟病病人的血糖量測依照傳統的量測方法可能會有高估或低估的問題。我們將討論末期腎病變病人對於口服降血糖藥在血糖控制有什麼挑戰、禁忌症、優點及缺點；也會另外針對腹膜透析的血糖控制來討論。

1. (2016).Diabetes care. Standards of medical care in diabetes-2016.Clinc Applied Res Edu,39,S1-S112.
2. Abe, M,Okada, K,Soma, M(2011).Antidiabetic agents in patients with chronic kidney disease and end-stage renal disease on dialysis: metabolism and clinical practice.Curr Drug Metab,12,57-69.
3. Adrogue, HJ(1992).Glucose homeostasis and the kidney.Kidney Int,42,1266-1282.
4. Arjona Ferreira, JC,Corry, D,Mogensen, CE(2013).Efficacy and safety of sitagliptin in patients with type 2 diabetes and ESRD receiving dialysis: a 54-week randomized trial.Am J Kidney Dis,61,579-587.
5. Brunelli, SM,Thadhani, R,Ikizler, TA(2009).Thiazolidinedione use is associated with better survival in hemodialysis patients with non-insulin dependent diabetes.Kidney Int,75,961-968.
6. Drucker, DJ,Nauck, MA(2006).The incretin system: glucagon-like peptide-1 receptor agonists and dipeptidyl peptidase-4 inhibitors in type 2 diabetes.Lancet,368,1696-1705.
7. Duckworth, W,Abraira, C,Moritz, T(2009).VADT Investigators: Glucose control and vascular complications in veterans with type 2 diabetes.N Engl J Med,360,129-139.
8. Filippatos, TD,Elisaf, MS(2013).Effects of glucagon-like peptide-1 receptor agonists on renal function.World J Diabetes,4,190-201.
9. Freedman, BI(2012).A critical evaluation of glycated protein parameters in advanced nephropathy: a matter of life or death: time to dispense with the hemoglobin A1C in end-stage kidney disease.Diabetes Care,35,1621-1624.
10. Garg, R,Williams, ME(2013).Diabetes management in the kidney patient.Med Clin North Am,97,135-156.
11. Hung, SC,Chang, YK,Tarng, DC(2015).Metformin use and mortality in patients with advanced chronic kidney disease: national, retrospective, observational, cohort study.Lancet Diabetes Endocrinol,3,605-614.
12. Kasichayanula, S,Liu, X,Lacreta, F(2014).Clinical pharmacokinetics and pharmacodynamics of dapagliflozin, a selective inhibitor of sodium-glucose co-transporter type 2.Clin Pharmacokinet,53,17-27.
13. Lalau, JD,Andrejak, M,Moriniere, P(1989).Hemodialysis in the treatment of lactic acidosis in diabetics treated by metformin: a study of metformin elimination.Int J Clin Pharmacol Ther Toxicol,27,285-288.
14. Mehrotra, R,de Boer, IH(2013).Should glucose-sparing prescriptions be expected to reduce the cardiovascular risk of peritoneal dialysis patients?.J Am Soc Nephrol,24,1713-1716.
15. Rachmani, R,Slavachevski, I,Levi, Z(2002).Metformin in patients with type 2 diabetes mellitus: reconsideration of traditional contraindications.Eur J Intern Med,13,428-433.
16. Salpeter, S,Greyber, E,Pasternak, GA(2010).Risk of fatal and nonfatal lactic acidosis with metformin use in type 2 diabetes mellitus.Cochrane Database Syst Rev,14,CD002967.
17. Scirica, BM,Bhatt, DL,Braunwald, E(2013).Investigators: Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus.N Engl J Med,369,1317-1326.
18. Shrishrimal, K,Hart, P,Michota, F(2009).Managing diabetes in hemodialysis patients: observations and recommendations.Cleve Clin J Med,76,649-655.
19. Shurraw, S,Majumdar, SR,Thadhani, R(2010).Glycemic control and the risk of death in 1484 patients receiving maintenance hemodialysis.Am J Kidney Dis,55,875-884.
20. Snyder, RW,Berns, JS(2004).Use of insulin and oral hypoglycemic medications in patients with diabetes mellitus and advanced kidney disease.Semin Dial,17,365-370.
21. Suzanne, M.(2015).Drug therapy: special consideration in dialysis patients, Antidiabetic Therapy in End-Stage Renal Disease.Seminars in Dialysis,28,337-344.