Inhibitors of renal sodium-glucose cotransporter type 2 (SGLT2) are a new class of antidiabetic drugs that have recently been introduced into clinical practice for the treatment of patients with type 2 diabetes mellitus. According to CREDENCE study, the inclusion of canagliflozin in drug therapy for patients with type 2 diabetes mellitus not only provides adequate control of blood glucose but also has a pronounced nephroprotective effect, which manifests in a significant reduction in the risk of progression of renal dysfunction in patients with stages 2, 3a and 3b CKD. The identification of nephroprotective effects in SGLT2 inhibitors, which is not related to their antihyperglycemic effect, suggests the possibility of using drugs of this class for drug therapy of patients with CKD of non-diabetic etiology. The review presents the data of clinical studies devoted to elucidating the participation of diuretic action and the associated decrease in blood pressure and venous stasis in the kidneys, improving glomerular hemodynamics and inhibiting the activity of intrarenal RAS in the mechanism of nephroprotective action of these drugs. Large-scale DAPA-CKD and EMPA-KIDNEY studies are currently underway, the results of which will provide information on the clinical efficacy and safety of dapagliflozin and empagliflozin in non-diabetic patients with the impaired renal function of varying severity, including those with stage 4 CKD. Initial data obtained in the DAPA-CKD trial indicated that dapagliflozin, when added to nephroprotective therapy, significantly improves renal outcomes not only in patients with type 2 diabetes but also in patients with CKD of non-diabetic origin, including those with glomerulonephritis, hypertensive nephropathy, and other kidney damage.

Резюме В обзоре представлены сведения об участии натрийуретических пептидов в нейрогормональном механизме, препятствующем повреждению сердца и почек у больных ХСН, и результаты, полученные при оценке клинической эффективности LCZ696 (сакубитрил / валсартан) в этой популяции пациентов, включая лиц с нарушенной функцией почек.Kuzmin O. B

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Резюме Хроническая болезнь почек встречается у большинства больных ХСН с сохраненной ФВ (ХСНсФВ) и является одним из основ ных ФР, ускоряющих развитие и прогрессирование диастолической дисфункции ЛЖ сердца. В обзоре представлены данные о влиянии хронической болезни почек на внутриклеточные сигнальные пути, нарушающие жесткость и диастолическое рас слабление кардиомиоцитов в ответ на воспаление и эндотелиальную дисфункцию коронарных капилляров, избыточную акти вацию симпатической нервной системы и дисрегуляцию системы натрийуретических пептидов, непосредственно участвую щих в формировании ХСНсФВ. Выяснение этих механизмов позволяет выявлять клеточные мишени для разработки новых подходов к лекарственной терапии пациентов с ХСНсФВ.

Amlodipine and selective dihydropyridine Ca2+ channels blockers of the second generation in addition to ACE inhibitors or replacing them antagonists of AT1-angiotensin receptors don’t improve clinical renal outcomes in hypertensive patients with chronic kidney disease. These drugs don’t eliminate intraglomerular hypertension that underlies hypertensive nephropathy and can have an adverse effect on the neurohormonal status of the organism, triggering the activation of the sympathetic and renin-angiotensin-aldosterone systems. The review presents the results of clinical studies evaluating the effectiveness of the use in this patients population of a new dihydropyridine blocker L-Ca2+ channels third-generation lercanidipine, dual blocker T/L-Ca2+ channels benedipine and dual blocker N/L-Ca2+ channels cilnidipine, that differ from their predecessors expressed renoprotective properties.