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2023, Número 3

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Rev Nefrol Dial Traspl 2023; 43 (3)


Protección cardiovascular, renal y cerebral, de los iSGLT2. Mecanismos hemodinámicos, tisulares y celulares implicados

Inserra Fl, Gustavo T, Castellaro C

Idioma: Español
Referencias bibliográficas: 62
Paginas: 184-196
Archivo PDF: 437.85 Kb.


RESUMEN

Luego de muchos años de búsqueda de nuevos mecanismos y estrategias de protección cardiovascular y renal, han aparecido los inhibidores del co-transporte sodio-glucosa o gliflozinas, demostrando un notable e inesperado efecto protector sobre las lesiones en varios órganos: corazón, arterias, riñones, cerebro y reducción de eventos. Dichos efectos se asociaron inicialmente a un mejor control de enfermedades metabólicas como la diabetes. Sin embargo, con el trascurso del tiempo y los resultados, se comprobaron mejorías funcionales y estructurales en dichos órganos, también en personas sin diabetes. Estas mejoras que fueron más allá de las respuestas inicialmente buscadas, se extendieron a los aspectos hemodinámicos y a los beneficios sobre las estructuras y funciones celulares y subcelulares asociadas a protección en los diversos tejidos. Estos hechos permiten entender la notable reducción de los diversos eventos observados en los pacientes, incluyendo una reducción de la mortalidad, que ronda el 30%. En esta revisión nos ocuparemos de mostrar las evidencias existentes en protección renal, cardiovascular y cerebral que se traducen en cambios notables en las guías de práctica clínica. Revisaremos también, los conocimientos mecanísticos celulares, particularmente la mejoría del funcionamiento mitocondrial, que lleva a un menor estrés oxidativo e inflamación. En resumen, la revisión intenta explicar al menos una parte de las razones que han permitido a estas drogas ocupar la primera línea de tratamiento en las enfermedades cardiovasculares y renales. Finalmente, daremos fundamentos que hacen pensar que estas drogas pueden ubicarse en un futuro en la prevención de enfermedades altamente prevalentes.


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