Background:Treatment with the dipeptidyl peptidase-4 inhibitors (DPP4i)and angiotensin receptor blockers (ARBs)in patients with type 2 diabetic nephropathy (DN)has not been well characterized.This study aimed to asses...Background:Treatment with the dipeptidyl peptidase-4 inhibitors (DPP4i)and angiotensin receptor blockers (ARBs)in patients with type 2 diabetic nephropathy (DN)has not been well characterized.This study aimed to assess the renoprotection of this combined treatment in DN patients. Methods:A total of 159 type 2 DN patients from 2013to 2015were enrolled retrospectively from a prospective DN cohort at the National Clinical Research Center of Kidney Diseases,Jinling Hospital (China).Fifty-seven patients received DPP4i and ARB treatment,and 102 patients were treated with ARBs alone.All patients were followed up for at least 12 months.Statistical analyses were performed using Stata version 12.0. Results:There were no significant differences at baseline for age,sex,body mass index,duration of diabetes,fasting blood glucose (FBG), hemoglobin Ale (HbAlc),and estimated glomerular filtration rate (eGFR)between the two groups.Antihypertensive and antidiabetie medication use was similar in each group except calcium channel antagonists (P =0.032).No significant changes in FBG and HbAlc were observed in the two groups after treatment.The eGFR decreased slower in the DPP4i +ARB group than in the ARB group at 12 months (△12months:-2.48±13.86vs.-6.81±12.52ml·min^-1·1.73m^-2,P =0.044).In addition,proteinuria was decreased further in the DPP4i +ARB group than in the ARB group after 24months of treatment (△24months:-0.18[-1.00,0.17]vs.0.32[-0.35,0.88], P =0.031).There were 36 patients with an eGFR decrease of more than 30% over 24 months.After adjusting for FB G,HbA1c,and other risk factors,DPP4i +ARB treatment was still associated with a reduced incidence of an eGFR decrease of 20% or 30%. Conclusions:The combined treatment of DPP4i andARBs is superior to ARBs alone,as evidenced by the greater proteinuria reduction and lower eGFR decline.In addition,the renoprotection of DPP4i combined with ARBs was independent ofglycemic control.展开更多
基金grants from the Key Research and Development Program of Jiangsu Province (No.BE2016747) National Natural Science Foundation of China (No.81500548and No.81500556).
文摘Background:Treatment with the dipeptidyl peptidase-4 inhibitors (DPP4i)and angiotensin receptor blockers (ARBs)in patients with type 2 diabetic nephropathy (DN)has not been well characterized.This study aimed to assess the renoprotection of this combined treatment in DN patients. Methods:A total of 159 type 2 DN patients from 2013to 2015were enrolled retrospectively from a prospective DN cohort at the National Clinical Research Center of Kidney Diseases,Jinling Hospital (China).Fifty-seven patients received DPP4i and ARB treatment,and 102 patients were treated with ARBs alone.All patients were followed up for at least 12 months.Statistical analyses were performed using Stata version 12.0. Results:There were no significant differences at baseline for age,sex,body mass index,duration of diabetes,fasting blood glucose (FBG), hemoglobin Ale (HbAlc),and estimated glomerular filtration rate (eGFR)between the two groups.Antihypertensive and antidiabetie medication use was similar in each group except calcium channel antagonists (P =0.032).No significant changes in FBG and HbAlc were observed in the two groups after treatment.The eGFR decreased slower in the DPP4i +ARB group than in the ARB group at 12 months (△12months:-2.48±13.86vs.-6.81±12.52ml·min^-1·1.73m^-2,P =0.044).In addition,proteinuria was decreased further in the DPP4i +ARB group than in the ARB group after 24months of treatment (△24months:-0.18[-1.00,0.17]vs.0.32[-0.35,0.88], P =0.031).There were 36 patients with an eGFR decrease of more than 30% over 24 months.After adjusting for FB G,HbA1c,and other risk factors,DPP4i +ARB treatment was still associated with a reduced incidence of an eGFR decrease of 20% or 30%. Conclusions:The combined treatment of DPP4i andARBs is superior to ARBs alone,as evidenced by the greater proteinuria reduction and lower eGFR decline.In addition,the renoprotection of DPP4i combined with ARBs was independent ofglycemic control.
