SGLT2 억제제: 신장 질환 환자를 위한 혜택

양파는 당뇨병, 심장 및 신장 질환에 좋은 효과를 나타내는 SGLT2 억제제로서 신장 질환에 대한 뜨거운 약물입니다.

### SGLT2 억제제에 대한 이해: 신장 질환을 위한 획기적인 치료제
* 👩 서울순천향병원 이혜경 교수가 원래 당뇨병 치료제로 개발된 **SGLT2 억제제가 만성콩팥병 치료에도 사용**되고 있다고 설명하고 있다.
* SGLT2 억제제는 인슐린 수치에 영향을 미치는 다른 당뇨병 치료제와 달리 **소변을 통해 포도당이 배설**되도록 하는 방식으로 작용합니다.
* 📉 만성 신장 질환 환자의 경우 신장 기능이 저하됨에 따라 **혈당 감소 효과는 감소**하지만 **저혈당 위험은 상대적으로 낮습니다.**
* 📚 처음에는 제2형 당뇨병 환자의 심장 안전성을 위해 연구되었지만, **나중에 신장 기능 저하와 단백뇨를 현저히 감소시키는 것**으로 밝혀졌습니다.
* 📊 이 약물은 사구체 여과율의 감소를 늦춰 **투석이나 신장 이식의 필요성을 약 15년 정도 늦출 수 있습니다.**
* 💊 국내에서는 **다파글리플로진과 엠팔리플로진이 신장 질환에 권장되는 SGLT2 억제제**로, 사용 가능한 사구체 여과율 범위에서 약간의 차이가 있습니다.
* 🚫 모든 신장 질환이 **SGLT2 억제제에 적합한 것은 아니며, 당뇨병성 신장 질환에 대한 데이터가 가장 많으며 IgA 신증과 같은 다른 질환에서도 유망한 결과**를 얻을 수 있습니다.
* 🌡 SGLT2 억제제는 또한 체중 감소와 혈압 감소로 이어질 수 있으며, **평균적으로 체중은 1~3kg 감소**하고 **수축기 혈압은 3~5mmHg 감소**합니다.

These days, the hot medicine for kidney disease patients is onion, which shows good effects not only for diabetes and heart diseases but also for kidney diseases. It is an sglt2 inhibitor. I have arranged a time to find out more about this medicine. Professor Lee Hye-kyung from the Nephrology Department at Seoul Soonchunhyang Hospital is here. Hello, Professor. Hello. I am Lee Ye-kyung from the Nephrology Department at Seoul Soonchunhyang Hospital. As a new medication for chronic kidney disease has been released, there is much interest. When taking sglt2 inhibitors, it is essential to gather information to maximize the effects and minimize side effects. I will explain the necessary information in an easy-to-understand way for the audience. First of all, the name of the sglt2 inhibitor medication is a bit complicated. Could you please introduce what kind of medication it is? It seems that many people are already familiar with sglt2 inhibitors. Initially, these sglt2 inhibitors were developed as type 2 diabetes treatments.

However, other diabetes medications either enhance the action of insulin or promote insulin secretion to lower blood sugar levels. On the other hand, SGLT2 inhibitors work differently by causing glucose to be excreted through urine, preventing blood sugar levels from rising. This is a distinct difference from insulin, as it acts separately. You mentioned that it works separately from insulin, but what about its function as a diabetes medication? It is known that in individuals with well-preserved kidney function, HbA1c decreases by approximately 0.6 to 1%. However, in patients with chronic kidney disease, when the glomerular filtration rate decreases to 62 ml/min, the effect of blood sugar reduction due to SGLT2 inhibitors diminishes. Therefore, in patients with chronic kidney disease, additional diabetes medications may need to be added to enhance the effect of blood sugar reduction. However, SGLT2 inhibitors are relatively low-risk in terms of hypoglycemia.

I can say that this is a safe medicine. This medicine was originally developed as a diabetes medication, but I am very curious about how it came to be used as a chronic kidney disease medication. Initially, research focused on the safety and effectiveness for the heart in type 2 diabetes patients. As the research progressed, it was confirmed that it also has significant effects on reducing kidney function decline and proteinuria. Therefore, the scope of research expanded from patients with relatively well-preserved kidney function and low albuminuria to those with decreased kidney function and high albuminuria. Recently, the indications have been extended to chronic kidney disease caused by other reasons besides type 2 diabetes, whether diabetes is present or not.

Regardless, it seems that there is a good protective effect on the kidneys, so this is quite good news for patients. Originally, while researching the effects on diabetic kidney disease patients as a diabetic drug, it was eventually proven in various studies that there is a protective effect on the kidneys as well. Then, what does it mean to slow down the decline in kidney function? SGLT2 inhibitors show effects on glomerular filtration rate after taking them for about 1 to 2 years or more compared to patients who do not take this medication. For example, if it is said that the glomerular filtration rate decreases by about 4.5 per year in patients receiving conventional treatment, taking SGLT2 inhibitors will result in a decrease of 2 per year in the glomerular filtration rate. Of course, treatment effects may vary depending on various factors, but approximately 15 years may be needed for a kidney transplant or dialysis.

Extending the period for treating nephropathy with [MUSIC]. In fact, in foreign countries, it is recommended to use it even for patients with advanced chronic kidney disease with a glomerular filtration rate (GFR) of 20 or higher. However, in Korea, the approval is currently for patients with a GFR of 25 or higher. Unfortunately, it is not covered by insurance if there is no diabetic nephropathy. However, it is expected that the approval criteria will be expanded to a GFR of 22 soon, allowing more patients to receive prescriptions at an affordable cost. The Korean Society of Nephrology is making great efforts to ensure that as many patients as possible can receive prescriptions at a reimbursable amount. In fact, there are various types of this medication. If you are curious whether there are differences between these medications, especially among SGLT2 inhibitors that have proven renal and cardiovascular protective effects so far.

In Korea, the prescription drugs available are Dapagliflozin and Empagliflozin. Therefore, for individuals like King Kong with chronic kidney disease, we recommend prioritizing the use of these two medications over other SGLT2 inhibitors. Although there is not a significant difference in the blood sugar lowering effect, since the usable range of glomerular filtration rate for each medication is slightly different, we recommend consulting with your primary care physician based on test results before obtaining a prescription. The causes of kidney deterioration are very diverse, and kidney diseases are also very diverse. So, are these medications suitable for all kidney diseases? First and foremost, the disease with the most accumulated data is, of course, diabetic kidney disease. In addition, they have shown very good results in glomerular diseases such as IgA nephropathy, and some effects are also observed in patients with kidney disease due to hypertension. However, in previous large-scale studies,

So far, patients with type 1 diabetes or those who have received immunosuppressive therapy such as steroids due to recent kidney disease have not been included in the reunion. Patients who have developed chronic kidney disease due to these causes may need more data before using it. Occasionally, there are cases where patients undergoing dialysis ask if they can take it. Are patients undergoing dialysis able to take it? Since there is still not much data, it seems that even patients who were taking existing medications are recommended to stop taking sglt2 inhibitors when they start dialysis. However, clinical trials of administering sglt2 inhibitors to patients undergoing dialysis are ongoing, so we need to see the results to determine whether prescribing sglt2 inhibitors to dialysis patients is actually effective and safe.

One of the reasons why SGLT2 inhibitors are receiving attention is that they are known to have effects on weight loss and blood pressure reduction. Could you please explain more about this? It is commonly known that in terms of weight, usually around 1 to 3kg is lost. Especially, it has been shown in studies that patients with high levels of HbA1c tend to lose more weight. As for systolic blood pressure, it decreases by about 3 to 5, so in reality, there are cases where people who were taking blood pressure medication end up reducing their dosage when using SGLT2 inhibitors. However, in cases where dizziness occurs when sitting up or low blood pressure is present, it is necessary to consult with the attending physician to adjust the existing medications. Another concern is that after taking this medication, there is a temporary drop in kidney function within a month or two.

I can see that you may have a lot of concerns about this. Various pieces of information are being poured out, and sometimes people cannot receive the correct information well, or unfortunately, they hear wrong information. SGLT2 inhibitors have many advantages as a medication, but there are also many points that need to be carefully considered. For those who are prescribed SGLT2 inhibitors for diabetes, kidney disease, including chronic kidney disease, it would be good to consult with nephrologists. If a situation arises where you need to deal with it, I hope you can receive appropriate help after consulting with them.

투석을 늦춰주는 약이 있다? SGLT2 억제제에 대한 모든 것!ㅣ대한신장학회

내 신장이콩팥콩팥

SGLT2 억제제가 신장 질환에 미치는 영향

SGLT2 억제제는 인슐린과는 다른 방식으로 혈당 수치를 낮춰 당뇨병, 심장병, 신장 질환 치료에 효과가 있는 것으로 나타났습니다.

만성 신장 질환이 있는 환자의 경우, SGLT2 억제제의 혈당 강하 효과가 감소하여 추가적인 당뇨병 치료제가 필요할 수 있습니다.

그러나 SGLT2 억제제는 저혈당 위험이 상대적으로 낮기 때문에 환자에게 유리한 선택이 될 수 있습니다.

당뇨병 치료제에서 신장 질환 치료제로 진화한 SGLT2 억제제

SGLT2 억제제는 처음에 제2형 당뇨병 환자의 심장 안전을 위해 개발되었지만, 신장 기능에 미치는 중대한 영향이 발견되었습니다.

이후 신장 기능이 저하되고 알부민뇨가 높은 환자를 대상으로 연구가 확대되어 제2형 당뇨병 이외의 원인으로 인한 만성 신장 질환에도 사용하게 되었습니다.

이러한 억제제는 사구체 여과율의 감소를 늦추어 환자의 신장 이식이나 투석 필요성을 잠재적으로 지연시킬 수 있는 것으로 나타났습니다.

국내에서도 사구체여과율(GFR)이 낮은 신장병 환자에게도 SGLT2 억제제를 처방할 수 있도록 허가 기준을 확대하는 방안이 추진되고 있습니다.

대한신장학회는 더 많은 환자들이 약제에 대한 접근성을 높이고 보험 급여를 받을 수 있도록 적극적으로 노력하고 있습니다.

다파글리플로진과 엠파글리플로진은 당뇨병성 신장 질환 및 기타 사구체 질환에 긍정적인 효과를 보이는 만성 신장 질환자에게 국내에서 권장되는 약물이지만, 검사 결과를 바탕으로 의사와 상의하여 적합성을 판단하는 것이 좋습니다.

신장 질환이 있거나 투석을 받고 있는 환자에서의 SGLT2 억제제 사용

제1형 당뇨병 환자 또는 면역 억제 요법을 받는 환자는 SGLT2 억제제 사용 대상에 포함되지 않았습니다.

투석 중인 환자에게 이러한 억제제를 사용하는 것에 대한 데이터는 제한적이지만 임상 시험이 진행 중입니다.

SGLT2 억제제는 특히 HbA1c 수치가 높은 환자의 체중 감소에 기여하는 것으로 알려져 있으며 수축기 혈압을 낮추는 데도 도움이 될 수 있습니다.

그러나 일시적인 신장 기능 저하를 유발할 수 있으며 투석 중인 환자에게 사용하는 것은 효과와 안전성에 대해 아직 연구 중입니다.

SGLT2 억제제는 약물로서 다양한 장점이 있지만, 특히 당뇨병과 신장 질환이 있는 사람은 신중하게 고려해야 합니다.

특히 만성 신장 질환이 있는 경우, SGLT2 억제제를 처방받은 사람은 신장 전문의와 상담하는 것이 중요합니다.

SGLT2 억제제 사용 시 의료 전문가의 적절한 도움과 지침을 구하는 것이 중요합니다.