Citation: | CHANG Ailing, ZHAI Yaran, WANG Yujin, ZHANG Jincheng, WANG Fangzhen. Effect of dapagliflozin on vascular function and renal function of patients with diabetic nephropathy[J]. Journal of Clinical Medicine in Practice, 2024, 28(10): 78-82. DOI: 10.7619/jcmp.20234180 |
To investigate the effect of dapagliflozin on vascular function and progression of renal function in patients with diabetic nephropathy (DN).
A total of 122 DN patients were randomly divided into control group and observation group, with 61 cases in each group. The control group received conventional treatment, while the observation group received conventional treatment and dapagliflozin. Glycometabolism, vascular function, renal function indicators and adverse reactions were compared between the two groups.
After treatment, there were no significant differences in fasting plasma glucose (FPG) and 2-hour postprandial glucose (2 hPG) between the two groups (P>0.05), but the glycosylated hemoglobin (HbA1c) level in the observation group was significantly lower than that in the control group (P < 0.05). The flow-mediated dilation (FMD) for 1 minute at resting state and FMD for 5 minutes at ischemia state were significantly higher in the observation group than those in the control group (P < 0.05); the estimated glomerular filtration rate (eGFR) and 24-hour urinary sodium level in the observation group were significantly higher than those in the control group, while the 24-hour urine protein level was significantly lower than that in the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05).
Dapagliflozin can effectively alleviate vascular function damage and inhibit the progression of renal function damage in DN patients.
[1] |
冯松涛, 王彬, 刘必成. 糖尿病肾病新型生物标志物的研究现状和展望[J]. 中华医学杂志, 2021, 101(10): 691-694.
|
[2] |
VAN BOMMEL E J M, MUSKIET M H A, VAN BAAR M J B, et al. The renal hemodynamic effects of the SGLT2 inhibitor dapagliflozin are caused by post-glomerular vasodilatation rather than pre-glomerular vasoconstriction in metformin-treated patients with type 2 diabetes in the randomized, double-blind RED trial[J]. Kidney Int, 2020, 97(1): 202-212. doi: 10.1016/j.kint.2019.09.013
|
[3] |
DHILLON S. Correction to: dapagliflozin: a review in type 2 diabetes[J]. Drugs, 2019, 79(18): 2013 doi: 10.1007/s40265-019-01239-1
|
[4] |
WHEELER D C, STEFÁNSSON B V, JONGS N, et al. Effects of dapagliflozin on major adverse kidney and cardiovascular events in patients with diabetic and non-diabetic chronic kidney disease: a prespecified analysis from the DAPA-CKD trial[J]. Lancet Diabetes Endocrinol, 2021, 9(1): 22-31. doi: 10.1016/S2213-8587(20)30369-7
|
[5] |
SALVATORE T, GALIERO R, CATURANO A, et al. An overview of the cardiorenal protective mechanisms of SGLT2 inhibitors[J]. Int J Mol Sci, 2022, 23(7): 3651. doi: 10.3390/ijms23073651
|
[6] |
PROVENZANO M, PUCHADES M J, GAROFALO C, et al. Albuminuria-lowering effect of dapagliflozin, eplerenone, and their combination in patients with chronic kidney disease: a randomized crossover clinical trial[J]. J Am Soc Nephrol, 2022, 33(8): 1569-1580. doi: 10.1681/ASN.2022020207
|
[7] |
HEERSPINK H J L, JONGS N, CHERTOW G M, et al. Effect of dapagliflozin on the rate of decline in kidney function in patients with chronic kidney disease with and without type 2 diabetes: a prespecified analysis from the DAPA-CKD trial[J]. Lancet Diabetes Endocrinol, 2021, 9(11): 743-754. doi: 10.1016/S2213-8587(21)00242-4
|
[8] |
MA T X, LIU X, REN Q, et al. Flow-mediated dilation analysis coupled with nitric oxide transport to enhance the assessment of endothelial function[J]. J Appl Physiol, 2021, 131(1): 1-14. doi: 10.1152/japplphysiol.00039.2021
|
[9] |
高彦彬, 刘铜华, 李平. 糖尿病肾病中医防治指南[J]. 中国中医药现代远程教育, 2011, 9(4): 151-153. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYY201104132.htm
|
[10] |
严陈燕, 邬步云, 徐琳, 等. 慢性肾脏病患者不同eGFR公式的结果差异研究[J]. 中华肾脏病杂志, 2017, 33(4): 249-257. https://cdmd.cnki.com.cn/Article/CDMD-10312-1018185454.htm
|
[11] |
皋文君, 刘砚燕, 袁长蓉. 国际肿瘤化疗药物不良反应评价系统: 通用不良反应术语标准4. 0版[J]. 肿瘤, 2012, 32(2): 142-144. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLL201202014.htm
|
[12] |
SAMSU N. Diabetic nephropathy: challenges in pathogenesis, diagnosis, and treatment[J]. Biomed Res Int, 2021, 2021: 1497449.
|
[13] |
DHILLON S. Dapagliflozin: a review in type 2 diabetes[J]. Drugs, 2019, 79(10): 1135-1146. doi: 10.1007/s40265-019-01148-3
|
[14] |
CHERTOW G M, VART P, JONGS N, et al. Effects of dapagliflozin in stage 4 chronic kidney disease[J]. J Am Soc Nephrol, 2021, 32(9): 2352-2361. doi: 10.1681/ASN.2021020167
|
[15] |
WHEELER D C, STEFANSSON B V, BATIUSHIN M, et al. The dapagliflozin and prevention of adverse outcomes in chronic kidney disease (DAPA-CKD) trial: baseline characteristics[J]. Nephrol Dial Transplant, 2020, 35(10): 1700-1711. doi: 10.1093/ndt/gfaa234
|
[16] |
FIORETTO P, DEL PRATO S, BUSE J B, et al. Efficacy and safety of dapagliflozin in patients with type 2 diabetes and moderate renal impairment (chronic kidney disease stage 3A): The DERIVE Study[J]. Diabetes Obes Metab, 2018, 20(11): 2532-2540. doi: 10.1111/dom.13413
|
[17] |
SCHECHTER M, JONGS N, CHERTOW G M, et al. Effects of dapagliflozin on hospitalizations in patients with chronic kidney disease: a post hoc analysis of DAPA-CKD[J]. Ann Intern Med, 2023, 176(1): 59-66. doi: 10.7326/M22-2115
|
[18] |
CASSIS P, LOCATELLI M, CERULLO D, et al. SGLT2 inhibitor dapagliflozin limits podocyte damage in proteinuric nondiabetic nephropathy[J]. JCI Insight, 2018, 3(15): e98720. doi: 10.1172/jci.insight.98720
|
[19] |
LIST J F, WOO V, MORALES E, et al. Sodium-glucose cotransport inhibition with dapagliflozin in type 2 diabetes[J]. Diabetes Care, 2009, 32(4): 650-657. doi: 10.2337/dc08-1863
|
[20] |
HU S Y, LIN C, CAI X L, et al. The urinary glucose excretion by sodium-glucose cotransporter 2 inhibitor in patients with different levels of renal function: a systematic review and meta-analysis[J]. Front Endocrinol, 2021, 12: 814074.
|
[21] |
VAN BOMMEL E J M, MUSKIET M H A, TONNEIJCK L, et al. SGLT2 inhibition in the diabetic kidney-from mechanisms to clinical outcome[J]. Clin J Am Soc Nephrol, 2017, 12(4): 700-710. doi: 10.2215/CJN.06080616
|
[22] |
SPOSITO A C, BREDER I, SOARES A A S, et al. Dapagliflozin effect on endothelial dysfunction in diabetic patients with atherosclerotic disease: a randomized active-controlled trial[J]. Cardiovasc Diabetol, 2021, 20(1): 74. doi: 10.1186/s12933-021-01264-z
|
[23] |
HASAN A, MENON S N, ZERIN F, et al. Dapagliflozin induces vasodilation in resistance-size mesenteric arteries by stimulating smooth muscle cell KV7 ion channels[J]. Heliyon, 2022, 8(5): e09503. doi: 10.1016/j.heliyon.2022.e09503
|
[24] |
JUNG H S, SEO M S, AN J R, et al. The anti-diabetic drug alogliptin induces vasorelaxation via activation of Kv channels and SERCA pumps[J]. Eur J Pharmacol, 2021, 898: 173991. doi: 10.1016/j.ejphar.2021.173991
|
[25] |
LI H L, SHIN S E, SEO M S, et al. The anti-diabetic drug dapagliflozin induces vasodilation via activation of PKG and Kv channels[J]. Life Sci, 2018, 197: 46-55. doi: 10.1016/j.lfs.2018.01.032
|
[26] |
HUANG K M, LUO X L, LIAO B, et al. Insights into SGLT2 inhibitor treatment of diabetic cardiomyopathy: focus on the mechanisms[J]. Cardiovasc Diabetol, 2023, 22(1): 86. doi: 10.1186/s12933-023-01816-5
|
[27] |
CHERTOW G M, CORREA-ROTTER R, VART P, et al. Effects of dapagliflozin in chronic kidney disease, with and without other cardiovascular medications: DAPA-CKD trial[J]. J Am Heart Assoc, 2023, 12(9): e028739. doi: 10.1161/JAHA.122.028739
|
[28] |
JONGS N, GREENE T, CHERTOW G M, et al. Effect of dapagliflozin on urinary albumin excretion in patients with chronic kidney disease with and without type 2 diabetes: a prespecified analysis from the DAPA-CKD trial[J]. Lancet Diabetes Endocrinol, 2021, 9(11): 755-766. doi: 10.1016/S2213-8587(21)00243-6
|
[29] |
XU B, LI S Q, KANG B, et al. The current role of sodium-glucose cotransporter 2 inhibitors in type 2 diabetes mellitus management[J]. Cardiovasc Diabetol, 2022, 21(1): 83. doi: 10.1186/s12933-022-01512-w
|
[30] |
ZHANG Y F, JIANG L, WANG J H, et al. Network meta-analysis on the effects of finerenone versus SGLT2 inhibitors and GLP-1 receptor agonists on cardiovascular and renal outcomes in patients with type 2 diabetes mellitus and chronic kidney disease[J]. Cardiovasc Diabetol, 2022, 21(1): 232. doi: 10.1186/s12933-022-01676-5
|
[31] |
ZELNIKER T A, RAZ I, MOSENZON O, et al. Effect of dapagliflozin on cardiovascular outcomes according to baseline kidney function and albuminuria status in patients with type 2 diabetes: a prespecified secondary analysis of a randomized clinical trial[J]. JAMA Cardiol, 2021, 6(7): 801-810. doi: 10.1001/jamacardio.2021.0660
|
1. |
樊佳佳,王永磊. 肾炎康复片联合替米沙坦治疗早期糖尿病肾病的临床观察. 实用中西医结合临床. 2024(24): 17-20 .
![]() |