939
HLAVNÍ506722001005185134178232252
TÉMA533422001003981147194
Duální111233001004583118134171186
efekt13153300100345589124152
ketoanalog14843300100336794133168206240256295333
esenciálních18343300100346399137168183217233270286316354
aminokyselin220433001003494109146185220258288324339354392
a2612330010034
inhibitorů26623300100145290105143158185224248287
SGLT2296533001003782113147182
receptorů31633300100235889123162188226251290
u3469330010036
seniorů352233001002864101116155180218
s3757330010028
chronickým38013300100296791130168183213247286346
onemocněním416433001003775111171210241278314352367427
ledvin:46073300100155089125141179194
tříleté4817330010026516784119146181
klinické50143300100345066103118149183217
sledování52473300100284479118157192228266281
|5584220010018
433564222001004174109
/35838040010732
Vnitř3660804001074592111139166
Lék.3845804001074184122140
2025;71(7):432-4404005804001074487128172185226267286329354368411453493519565612657
/47078040010732
VNITŘNÍ48058040010745106127171220280301
LÉKAŘSTVÍ5127804001074084130188235280325377399
www.casopisvnitrnilekarstvi.cz42580400107651332012142542953293774274464795215705896176436927117307748128548809159449871007102310631101
Dual425560015078146209243
effect704560015062109157219272319
of1059560015065112
keto1207560015067127173239
amino1482560015063163196263329
acids1847560015063116149216271
and2154560015063130198
SGLT22388560015063135193251321
receptor2745560015048110162223291338403451
inhibitors3232560015033100167200268301347413460514
in3782560015033100
seniors3918560015054116183216282330384
with4338560015091124170238
chronic4612560015052119167233300334386
kidney5034560015066100167234296362
disease:425700015067100155216280334396431
three892700015046114162224286
years1214700015067127190238292
clinical154270001505386120187220272336369
monitoring1947700015099165232265311377424457524591
In42590001212479
last52290001212371110143
decades,683900012156106152200256306346366
there106790001213388138171220
is130590001212362
growing138590001215688142215238293349
number1751900012156110193249300332
of210190001215584
seniors220390001213989144167222255295
over2516900012154101150183
652716900012151101
years283590001214695143175216
with306890001217497130185
chronic327190001214499131185241264308
kidney359790001214771127182233279
disease389490001215679118168215254304
(CKD).421690001212984137204230248
Beside4482900012154104144166223273
of477290001215584
development4874900012156106153202226281337421471526558
in545090001212378
technology425104001213382128182237292316371427475
of918104001215584
dialysis1019104001215780127151198237260299
and13361040012148103159
kidney1513104001214771128183233279
transplantation1810104001213365114169208264288336391423471504527581637
there2465104001213388138170220
is2703104001212362
a27831040012148
lot2852104001212479111
of2981104001215584
patients30831040012156105137160210265298338
who34391040012173129184
are3640104001214881130
not37881040012155110143
indicated3949104001212378134157202251283332389
for4356104001212984116
succefull4490104001214094139182231260316339362
management48701040012183131186234290340423473529561
in5449104001212378
dialysis425118001215680127151198238261300
–7451180012150
transplantation814118001213366114170209265289337392425474506529584640
programme1474118001215789144201233282365448499
due19921180012157111162
to2173118001213488
serious2280118001214090123147202257296
other2596118001215588143193226
organ2842118001215588143191247
damages.31081180012157105188236292342382403
In3531118001212479
our36301180012155110143
previous3792118001215790140188211266322361
studies4173118001213973128185208258298
we44901180012174123
have46331180012156104150199
confirmed4852118001214598154183209242325376433
longterm5305118001212479134191425132001213382114197
effectivity640132001215079111161206241264312335368417
of1075132001215483
conservative1176132001214497152191241274324372404427475523
management17171320012183130185233288338421471526558
of2292132001215584
CKD23931320012158111178
3b-425881320012151107140194
on28031320012154110
modified29301320012183138194217246272322379
low-protein3326132001212478150181239272326358407430485
diet3828132001215679129162
(LPD)4007132001212974127191217
supplemented4242132001213993149206229279362412467499548605
with4864132001217397129184
keto5066132001214695128181
amino52651320012148130153208262
acids425146001214893116173212
(KA)661146001212982147174
in860146001212378
old963146001215579135
patients11231460012157106138161211267299340
over14871460012155103152184
8016961460012151103
years.1824146001214796144177217239
In2087146001212479
last2191146001212472111145
decade,23601460012157107153201258308328
there2713146001213388139171221
were29591460012173123156206
published31891460012157113169193216255311361418
very3632146001214897130180
important38371460012123106163219252288337392424
studies4286146001214073128185208258298
supporting4608146001214094151208264297333356411467
protective5100146001215790144177226272307330379428
effect425160001215080112163208244
of691160001215584
SGLT27981600012149113161204257
receptor1077160001213383128177234267321354
inhibitors1454160001212378134157213237270324357397
(dapagliflozin1874160001212882130187235291315338367393448490514569
and24651600012149104160
empagliflozin)26481600012150134190239295318341371397452494517573598
in3268160001212479
CKD33691600012158111179
pacients,35711600012156105150173223279311352373
in3966160001212479
diabetics4067160001215780128184235269292336377
as4467160001214887
well45761600012174123147171
as4769160001214887
in4879160001212378
patients49801600012157105138161211267299340
with5342160001217497130186
cardiorenal425174001214594126182205260293343399447470
syndrome919174001213987144200233287371421
(renal1364174001212858108163211235
demage16221740012157107190239294345
in1990174001212379
chronic20921740012145100132187242266310
cardial2426174001214493126182205253276
failure).2726174001212978101124179211261287305
New30541740012166117190
modification32671740012184139196219249275320368401424479535
in3825174001212379
conservative3927174001214598154193244276328376409432480529
management44791740012184132187235291341425475531563
is5066174001212362
LDP51511740012148114167
with5342174001217397130185
keto425188001214796129183
amino6311880012148131154210265
acids918188001214893116173212
and11521880012148104160
SGLT213351880012149113161204257
receptor1614188001213383128177234267321354
inhibitors1991188001212378134157213237270324357398
simultaneously2411188001214062145200224257305361411467522562585632
in3066188001212378
long-term3167188001212378134190222255305337421
follow3611188001212984108131186259
up.38921880012155112132
Randomised40461880012154103158215270353377416466523
prospective4592188001215790144183240291337372395443492
metabolic51071880012183134167216273328353375420
balance4252020012157106129177233278327
study780202001214073128185233
comprises1041202001214599182239272296335385425
for1494202001212984117
a16402020012148
period17092020012157108141165220277
of2015202001215484
3621272020012151102
months22572020012184139195227282321
4226062020012152100
patients27342020012157106138161212267300340
in3103202001212378
age32092020012149105155
group3392202001215689143199256
of3676202001215584
65–8037882020012151101153207259
years4075202001214796145177218
with4321202001217397130185
CKD45352020012158111179
3b-447422020012151107141196
on49662020012155111
long-term5105202001212479135191223256305338422
low-protein425216001212479152183241274329361411434490
diet935216001215780130164
of1119216001215584
0.81224216001215172125
g/BW/day1369216001215691146229260312360406
(LP1795216001212975128
diet)1944216001215679129163190
supplemented2155216001213994150208232282365416472504553611
with2786216001217498131186
keto2993216001214796129183
amino31972160012148131154210265
acids3483216001214893115172211
in3715216001212379
a38142160012149
dose38842160012157112151202
of4106216001215584
1004211216001215298151
mg/kg43832160012183140174222277
BW/day.46812160012154138168220268314330
At5032216001216193
the5145216001213389139
same5305216001213988172222
time,425230001213356139190210
226612300012151102
patiens7902300012157105138161211267306
were11222300012174123156206
on13552300012154110
medication14922300012183134191214259308340363418474
of1992230001215584
102103230001215198
mg22272300012184140
of2393230001215584
SGLT225042300012149114161204257
receptor2787230001213383129178235268322355
inhibitor).3168230001212479134157214238271325358384402
Control35972300012158111167200232287311
group3934230001215689143199255
consisted4216230001214598154193216255289338395
of4638230001215584
2047482300012152102
patients48762300012157106139162212267300340
in5243230001212378
CKD53482300012158111179
3b-44252440012151107141195
on6462440012155111
the783244001213388138
same947244001214089172223
low-protein1195244001212479152184242275329362411435490
diet1711244001215679130163
with1900244001217497130185
keto2111244001214796130184
amino23202440012149132155210265
acids2611244001214893116173212
only28492440012155110134181
(standart3056244001212966100149204261309341377
management).34592440012183131187235291341424475531563590609
There40932440012150106157190240
we43582440012174124
no45072440012156111
significant4644244001213962118174197226252297346401433
difference5103244001215780109142192225275330375424
in425258001212379
GFR5252580012165114166
and7122580012148104160
measuresed8942580012183134182221275308358397448505
biochemical1420258001215781136181236287370394438487511
parameters19522580012157106138187270320354403436476
in2450258001212378
Group2550258001216497152207264
I28352580012124
and28802580012149104161
Group3062258001216598152208264
II3348258001212448
at3417258001214881
the3519258001213388139
start3679258001214074122155191
of3891258001215584
the3997258001213388138
study.4157258001213973128185232249
At4427258001216193
the4541258001213388139
end47012580012150106163
of4885258001215584
the4990258001213489139
study5151258001213973128185232
we54052580012173123
confirmed425272001214599154183209242325376433
in881272001212379
Group982272001216598153208265
I12692720012124
significant1315272001213962118173196226252297345401433
decrease17712720012156106152184234282321372
of2166272001215584
proteinuria2272272001215790145178227250306360393416464
and27592720012148103160
ACR29422720012161116169
(Gr3134272001212891124
Ia3281272001212472
vs.3376272001214887108
Gr3507272001216598
Ib,3628272001212380100
p37502720012157
<38202720012159
0.025),3892272001215171123172222249268
as4182272001214988
well42922720012174123147171
as4485272001214888
decrease45952720012157107153185235283322373
compared4990272001214599182239288320370427
to5440272001213387
control425286001214599154187219274298
Group743286001216598153208265
II1028286001212448
(Gr1096286001212991124
IIa124128600121244896
vs.1357286001214888109
IIb1487286001212447104
p16122860012157
<16812860012160
0.05).1753286001215272123174200219
We19922860012185133
found2145286001212984139195251
also2417286001214872111166
better26032860012157108142177226259
parameters28832860012156105138186269320353403435476
in3379286001212479
nitrogen3478286001215679112145199256306362
metabolism38602860012184134168217273329353376415498
(S4379286001212875
urea,Gr4475286001215587137185206270303
Ia4798286001212473
vs.4891286001214888109
Ib5020286001212481
and51222860012148103160
IIa530228600121244896
vs.5419286001214887108
IIb,425300001212447104123
p5663000012156
<6343000012160
0.05)706300001215171122172198
and9213000012148103159
in1098300001212378
protein1193300001215789144176225248303
metabolism15133000012183133166215271326350373411494
(S2024300001212975
transferin,2120300001213365113168207236286319342397417
Gr2555300001216497
Ia2669300001212472
vs.2759300001214786107
Ib,288430000121248099
p30013000012156
<30703000012159
0.05).3141300001215171122172198217
In3375300001212479
Group3471300001216597151206263
I37513000012124
we37963000012173122
confirmed3936300001214497153181207239322372429
correction4383300001214498130163212257292315370425
of4825300001215584
fasting4926300001212978117150173228283
glycaemia,52273000012155791261692172674253140012183107154176
as623314001214887
well7323140012174123147170
as925314001214887
of1034314001215584
total1140314001213488120169193
cholesterol,13553140012145100155179229269303352385439463484
LDL-cholesterol18613140012147113161184231286341365415455489538571625650
and25333140012148103160
triglycerides271531400121336689145168216260309342365422472512
(p3249314001212885
<33473140012159
0.05).3419314001215171123173200218
In3659314001212480
Group3761314001216498152207264
I40473140012124
(Gr4093314001212890123
Ia4239314001212472
vs4333314001214888
Ib)4443314001212480106
significantly4571314001214063119174197227253297346401434457504
decreased50983140012156106152184234282321372429
systolic425328001214088127161215239262307
(p756328001212885
<8533280012160
0.025)925328001215272123172223249
and11983280012148104160
diastolic1382328001215679127167200254278301346
(p1752328001212885
<18503280012159
0.05))1922328001215171123173200224
blood2170328001215781136192249
pressure2443328001215790140179218273305355
(p2822328001212885
<29193280012160
0.025)2991328001215272123172223249
and32643280012148104160
values3448328001214896120175225264
of3736328001215584
NT-proBNT38443280012166116143201234288343409459
(Gr4327328001212991124
Ia4475328001212472
vs.4571328001214887109
Ib)4703328001212481107
also4833328001214972111166
significantly5023328001214062118174197226252297346401433457504
decreased4253420012156107152185235283322372430
(p881342001212885
<9783420012160
0.02).1051342001215171122171197216
Values12933420012156101125179230269
of1588342001215584
GFR16993420012164113165
during18913420012156111143167222278
the2195342001213388139
follow2360342001212984108132187260
up26463420012155112
stay2784342001213973122168
stable,2978342001214073122179203253273
compliance3277342001214599183239263286334389434483
was37873420012173122161
very3974342001214897130180
good41813420012155111166224
and44313420012148103160
adherence46173420012148105160211244293349394443
to5086342001213387
the5200342001213388138
diet5364342001215780130164
exeeded425356001215097145195252302359
808013560012151103
%.9163560012178100
Dual10343560012166121169192
effect1243356001215079111161206241
of1502356001215483
keto1603356001214695128181
amino18023560012148130153207262
acids2082356001214792114170209
and23093560012148102158
SGLT224853560012149113160202254
receptor2757356001213282127175232265318351
inhibitors3125356001212378133156212235268321354394
was35363560012173121160
safe3713356001214088117166
and38973560012148103159
long4073356001212478133189
term4279356001213382115198
effective4494356001215079111161206241264312360
with4872356001217396129184
LP5073356001214799
diet5190356001215679128161
and53693560012148102159
offers425370001215584117167200240
new6863700012156106180
alternative887370001214871104154187242290323346394443
for1352370001212984117
conservative1490370001214598154193244276328376409432480529
management20403700012184132187235291341425475531563
in2625370001212378
risk272437000121335796142
CKD28873700012158112179
3b-430883700012151107140195
old3304370001215579136
patients34613700012157106138161211267299340
with3822370001217497131186
diabetes4029370001215679127184235268318357
and44073700012149104160
cardiorenal4589370001214493126182205260293343398446470
syndrome.5080370001214088144201233288371422442
Key4253870012358108158
words:6043870012374130166224266290
chronic9153870012145100132187243266310
renal1247387001213282138186209
insufficiency,1477387001212479118172202235261305328379434479529545
SGLT220433870012149114161204257
receptor2321387001213383129178235268322355
inhibitors,2697387001212378134157213237270324357398419
keto3137387001214796129183
amino33413870012149132155210265
acids,3627387001214993116173212233
metabolic38813870012184134168217273329353376421
study,4323387001214074128185233249
seniors.4593387001214090146169224257297318
Úvod4254370013874136196259
Více565454001074665105148
než737454001074993130
polovina891454001075099119167207227275316
nemocných1231454001074893166215256304343382430
v16864540010741
dlouhodobém1747454001074967116164212260310359409454527
dialyzačním2299454001074968108127167206248289337355429
programu2752454001075077124425468001074976118192240
přesahuje692468001075077120154196245292312356
svým1074468001073477120195
věkem1296468001074184123166240
651563468001074487
roků1677468001072674113161
a18654680010741
rychle1926468001072770110159178222
přibývá217546800107507796146186231273
pacientů2474468001075092133152196245272320
ve2821468001074184
věkové425482001074083121167207250
kategorii691482001073880106149198246272291310
stáří,1017482001073362103129147162
tj.119648200107274662
nad1274482001074888137
751427482001074485
let.152848200107196290106
Přes1650482001074570112146
rozvoj1812482001072673108151198217
dialyzačních2045482001074967107126165204245285333351391438
technologií2499482001072870111158206254273321370389407
a4254960010740
transplantačního48449600107285495142174223242282329355396435483501550597
programu1097496001074976122171197238310357
proto1470496001074975122148194
přibývá168049600107497594143181225265
nemocných,1961496001074892164212252300337376423439
u24154960010748
kterých2482496001073768109135177216264
biologický2761496001075068116425510001071966115133172209251
věk692510001074082119
s8275100010733
dalším879510001074888106137155227
orgánovým1125510001074773120160207254294336409
poškozením1550510001074997130166213247289336354426
neumožňuje1992510001074791137209257292339385404446
transplantaci245451000107285494141173222241280327353394433451
ledviny,425524001071965116158178228267279
ale732524001074161106
často865524001074184118148196
ani1088524001074291110
dlouhodobou1226524001075069119168218267319368420470520
úspěšnou1773524001074982133179213263312362
léčbu2162524001071965107157207
v23965240010742
dialyzačním2465524001075069111131172212255297346365440
programu.425538001075077125175202244318366382
Při83453800107467191
četných945538001074083111160199239287
orgánových1259538001074875124165214262303347387435
komorbiditách1721538001073886161210237288307357376404446487535
a22835380010741
při234453800107507796
použití24675380010750100148185205233252
současných2746538001073482131425552001074081115163201241289
technologií734552001072870111159207256275324374392411
dialyzační1165552001074967108127167206248288336355
léčby1540552001071963104153193
je1753552001071963
jejich183655200107196382100141189
prognóza2045552001074976123173221270305348
špatná.2413552001073383124151200240257
Vázne2690552001074685122171215
i4255660010719
kompartment464566001073885159209250276307381426474501
sociálních984566001073482124142182201249268308356
služeb1359566001073453100137180229
a16085660010741
celková1669566001074082101139186227268
kvalita1957566001073882123142160189230
života220756600107365596143171212
klesá2439566001073859102136178
(1,263756600107246374
2).273156600107436679
V5655800010747
posledních6335800010752103138157203255305325366416
letech107758000107206595139182232
se1337580001073480
objevily14455800010749101121167209230250291
studie1764580001073565115166186231
o20235800010749
úspěšné2094580001074983135181216266312
dlouhodobé2434580001075070120170220270322373425471
konzervativní425594001073886135172215241286327354373415464483
léčbě934594001071963105154199
s11595940010734
podáváním1213594001075099150190230272320339413
modifikovaných16525940010774123173192216236274321362403452490530578
nízkobílkovinných2257594001074867104142190240259280318365406425474522560600648
diet425608001074967110138
doplněných579608001074896145165212255303341380427
ketoanalogy1022608001073881108154195243283301349398438
esenciálních1476608001074477121168208226266285332350390437
aminokyselin19296080010741113132179227265307341384403421468
u24146080010747
nemocných2480608001074892165212253301339378425
nad425622001074889138
80590622001074488
roků704622001072774113161
věku891622001074184122170
(3–6).1087622001072467113160182195
Jejich130962200107317594112153201
více1536622001074160100143
než1705622001074892129
dvouletá1861622001074990137186204248276318
prosperita2205622001075077124157206251278297325367
při259862200107507696
nízké2720622001074867103142185
hodnotě425636001074897147195243271313
renální761636001072770118158177225244
funkce1028636001072372120158198240
kolem1291636001073886105149223
101537636001074483
ml/min1644636001077392125196215262
(0,17193063600107236681120156
ml/s)2110636001077392125155176
ukazuje2309636001074886128166214233277
na2609636001074889
možnost27216360010774122158425650001074897130159
konzervativního610650001073885134170213240284325353371412461480530578
léčení1214650001071963104146194213
chronické1452650001074088115162210229269307350
renální1827650001072770118159178225244
insuficience2096650001071967100147171191231250293342382425
(CKD2546650001072473118177
4–5)2749650001074491134156
u4256640010748
indikovaných493664001071866116134172219260301349388427475
seniorů991664001073378126144192219268
jako128166400107196098145
alternativa144966400107405987130156205246273292333374
dlouhodobé1846664001074968116164212261311359409454
dialyzační2323664001074967108127167206248288336355
léčby.2700664001071963104154193205
Navíc425678001075797136155195
je636678001071962
třeba71467800107285496145186
vzít91667800107417998125
v10576780010741
úvahu1117678001074788129176223
skutečnost,1356678001073471118146188228276324357385401
že1773678001073678
ve1867678001074183
stáří1966678001073462103129147
klesá2129678001073858102135176
hodnota2321678001074896145193240267308
glomerulární264567800107496711518823242569200107277594134161210228
filtrace,6766920010724446290117159199242256
která955692001073869112138180
u11586920010748
seniorů1225692001073478126145193220268
vysokých1516692001074184118167205248288336
věkových1875692001074084122169209252292340
kategorií2238692001073880108150200248275295313
dosahuje2574692001074998131173221269287331
fyziologicky425706001072367105125172192240289308348386428
kolem870706001073885104148221
501108706001074386
%12117060010766
úrovně1293706001074874121161210253
glomerulární1563706001074967115189233259307326366393441459
filtrace20397060010723436289116157198240
ve2295706001074184
věku2395706001074184121169
20–302581706001074486134175218
let281570600107196391
(7–8).425720001072468108154176190
Snížená638720001074290108145187236276
hodnota938720001074896147195243270312
glomerulární1273720001074968116190235261309328369395444463
filtrace17597200010724446290117159199242
proto2024720001075077124151198
musí22457200010774121154173
být2441720001075089120
vztažena2585720001074079110152189231280320
k4257340010738
věku483734001074184123171
pacientů.681734001075091132151195243270319333
K10417340010745
podpoře1106734001075099150199249276319
léčebné1451734001072064105148198247291
alternativy176873400107426189132158207248276295336379
konzervativní2174734001073886135172215242286328355374415465483
nefrologie2684734001074893117145192425748001071968118137182
přispívají63374800107507797130180199240282302320
i9807480010719
závěry1019748001073779120163190233
deklarující,1279748001074994132153194221270289308348367383
že1688748001073780
pozdější1795748001075099135184228247280299
zahájení2120748001073780128169189233282300
dialyzačního2447748001074968109128169208251292340359409458
léčení425762001071963104146194212
u6537620010748
seniorů721762001073377125143191218266
může10037620010774121157200
prodloužit1220762001074976123173191239287324343371
údobí1607762001074897145195214
kompenzace1837762001073885159208253301338380420462
při231676200107497695
konzervativní2427762001073885134171213240283325352370411460478
léčbě425776001071963104153198
v6487760010741
predialýze708776001075077120170189229248288327370
a11027760010741
celkově1163776001074082102139187227270
prodloužit1458776001074976123173192240289325344373
dobu1855776001074997147196
aktivního2075776001074179110129170219238287336
života243677600107365596143171212
těchto2673776001072870111159186232
nemocných.3047440001074994168217259308347388436453
Současně3527440001074291140181223257306350
užívané3904440001074886105147189238283
výpočtové4214440001074185136186228258306347390
hodnocení4631440001074998149198247289332381400
glomerulární5058440001074968117192237264313333374401450469
filtrace30474540010724436290117158199241
u33154540010747
seniorů3382454001073478126145193220268
je3676454001071963
často3765454001074182115144191
zatížené3982454001073679106125161204252296
značnou4305454001073685125166214262310
chybou4642454001074088126177226274
danou4942454001074990138187235
sníženou5203454001073481100136179227276324
hodnotou3047468001074897147196244272319367
sérového3440468001073478105152193236285333
kreatininu3800468001073866109150177196244263311358
při418546800107507796
úbytku4307468001074898138169207256
svalové4589468001073476118137185226269
hmoty48854680010748122170198241
(7–9).5152468001072468109153175189
Jsou5367468001073164112161
ale3047482001074059102
také3165482001072868106148
přítomny332948200107497594121167240287325
další3670482001074988107139157
změny38434820010735109152199237
elektrolytového4096482001074362105143173199245264304334380420462510557
a46694820010741
vodního4729482001074087136183201250298
metabolismu,50434820010773116143184233281300318350423469484
které3047496001073869111138181
jsou3248496001071952100148
charakteristické3416496001074088129155197235265308334354386415434475512555
pro3991496001075077124
vyšší4135496001074083117150169
seniorský4323496001073478126145193220254292335
věk.4677496001074184122140
Dlouhodobé3187510001075980129179228278329378430476
bilanční369051000107517190132181222272291
studie4008510001073464113164183228
prokázaly4264510001075078126166209247291311352
protektivní4643510001075078126155198237269289331381400
metabolický50715100010775120149191242292313332373412456
účinek3047524001074888106154198237
ketoanalog3300524001073881109156197245286305353403
esenciálních3720524001074377121169210228269287335354394442
aminokyselin41785240010741115133181229268311345389408426474
u46695240010748
nemocných4736524001074893166215256304342382430
s51835240010733
chronickým52365240010740881141612102282693047538001073881155
onemocněním3218538001074897140214262303351395443461534
ledvin,3769538001071962112153172220235
u40215380010748
diabetiků4088538001074967107157201229248285333
i44385380010718
nediabetiků.4476538001074892142160200250294322341378426441
Efekt4933538001074265108146177
ketoanalog5126538001073881109155196244285303351401
je3047552001071963
hemodynamický3130552001074892166214264305354395468487527565608
i37575520010719
metabolický,37965520010774118146187237286306324364402445456
a42725520010741
to4333552001072874
glomerulární4427552001074968116190234261309328369395444462
i49095520010719
tubulární4948552001072775125173192233259308326
(10).5294552001072464103126139
V31875660010746
poslední32545660010750100134153198249298316
době3597566001075099150195
byly3819566001075091111151
publikovány39975660010751100150170189227275316359407447
významné4470566001074286125175216291340385
studie4881566001073464113163182226
prokazující5134566001075178126165208246295315334374393
protektivní3047580001075077124151193231262281322371389
účinek3453580001074888107155199237
inhibitorů3707580001071866114133182201229276303351
SGLT24075580001074298138174219
receptorů4311580001072770111153203230277304352
(dapagliglozin4680580001072470111160202251270288337356404440459507
i52045800010718
empagliflozin)5242580001074411716720825830475940010719376184132167186234255
u33195940010748
renálních3386594001072770118159177225244284331
pacientů,3734594001075091132150194242269317332
jak408359400107195997
u41975940010747
diabetiků,4264594001074967108157202230249286334350
tak4630594001072869107
u47545940010748
pacientů4821594001075091132150194242269317
s51545940010734
kardiorenálním52075940010738811071551742222492913047608001074888107154172245
syndromem3308608001073474123172198244318362435
(poškození3759608001072473122155192239274317364382
ledvin4158608001071962112152172219
při439360800107507695
srdečním4504608001073359107150191239257330
selhávání).485060800107337796143183223264311330358370
Dochází52376080010758106147194235271290
zde3047622001073785130
vedle3203622001074185135155199
blokády3429622001075070118157200250291
transportu374662200107285597146179229278306337385
glukózy4158622001074968116155202238281
též4466622001072871108
k46016220010738
ovlivnění4659622001074989109128169219263312331
transportu501662200107285597146179229279306337386
Na5428622001075899
v30476360010741
proximálním3107636001075077124162181255296315362381454
tubulu3588636001072775125173192239
ledviny,3854636001071963113154173221260271
k41526360010738
ovlivnění4210636001074788107126167216260308327
systému4563636001073374108137180254301
RAS48906360010746100143
(renin-angiotenzin-aldosteron),5059636001072448911401582062342753233723914393047650001072973123161181231260303323374424459489533561610660682697
a37726500010742
tím3835650001072848124
vedle3987650001074287138158204
snížení4219650001073484103141186236255
TK,4502650001074391110
proteinurie4640650001075179128156201220270319347367412
i50806500010720
k51216500010739
přímému518165000107517999175221297346
ovlivnění3047664001074787106124164212255302320
progrese3383664001074975121171196238271315
renálního3713664001072769116156174221239288335
onemocnění4064664001074795139211258299346389436454
včetně4534664001074079120147195238
zlepšení478866400107365598146179222269287
metabolické50916640010773116143184233281300318357394436
kompenzace3047678001073885159209254302339381422464
diabetu3531678001074968108157202230278
i38296780010719
kardiální3867678001073981107155174214233281300
insuficience4186678001071967100147171191231250293342382425
(11–14).463067800107246498140178217239252
Nová31876920010757106146188
léčebná3392692001072064105147197245286
alternativa369669200107405987130156205246273292333374
konzervativní4088692001073885134171214240284326353372413462481
nefrologie4586692001074893116144191211259309328372
je4975692001072063
v50566920010741
současném5117692001073382130170211245292337410
podávání3047706001074998147187226267315333
obou3396706001074897145193
přípravků,360570600107497694143170211250288336351
a39727060010740
to4031706001072874
v41217060010740
rámci4180706001072768140180199
již439570600107193773
dlouhodobě4484706001074967115162210257307354404448
používané4948706001074998145182200241282329373
léčby5337706001071962103151190
dietou3047720001074968111139186234
s33067200010733
ketoanalogy3359720001073881109156197245286305353403444
s38277200010734
potenciací3881720001075099126169217257276316357375
pozitivního4281720001075099134154182200241290309359407
efektu4713720001074467111149180228
v49667200010740
oblasti5026720001074898118158192221239
ledvin,5290720001071963113154174222237
diabetu3047734001074967108157202229277
i33417340010719
srdce.3379734001073460108148190205
Limitace3601734001074059132150178220260302
je3920734001071963
dána3999734001074990138178
úrovní4194734001074774120161209228
renální4438734001072770118158177225243
funkce4698734001072372120158197239
(s4954734001072355
rizikem502973400107274682102139182255
ev.530173400107448496
hyperkalemie54137340010748873047748001074993119156198216259331349392
při345474800107497594
aktivaci3564748001074077107125165206245263
RAS3843748001074598140
při399974800107497593
poklesu4108748001074997135155198230276
GF4400748001075596
pod4512748001074997146
0,334674748001074357101141
ml/s),4831748001077391123152173186
což5032748001074085120
lze516874800107195496
upravit5280748001074795122162201220247
podáváním3047762001075099149190229271319337411
diuretika3481762001074968115142185212231269311
typu3816762001072870121169
furosemidu,400976200107237298145179223297315365412428
který4460762001073869111138181
tito466476200107284775122
pacienti4809762001075091132151194243269288
většinou5121762001074083111146164212260308
již545376200107193874
dlouhodobě3047776001074967115162210258307355404449
užívají.3512776001074783102143184202220236
Model37647760010769117167210229
studie4009776001073462110158177220
navazuje4245776001074888127168205253271315
na4576776001074888
naše4680776001074888121164
dlouholeté4860776001074967115162210258277320348390
klinické526677600107385876123141181219261