First Department of Medicine, Wakayama Medical University, 811‑1 Kimi‑idera, Wakayama City, Wakayama, 641‑8509, Japan.
Department of Medical Technology, Faculty of Health Sciences, Kansai University of Health Sciences, Sennan, Osaka, Japan.
Sci Rep. 2023 Sep 29;13(1):16373. doi: 10.1038/s41598-023-43614-9.
The renal protective effects of sodium-glucose co-transporter 2 (SGLT2) inhibitors and renin-angiotensin system (RAS) inhibitors on diabetic nephropathy without albuminuria have not been fully investigated. This retrospective cohort study focused on patients with type 2 diabetes mellitus who had a baseline estimated glomerular filtration rate (eGFR) of > 30 mL/min/1.73 m, and a urinary albumin-to-creatinine ratio < 30 mg/gCr. After propensity score matching, using covariates such as age, body mass index, systolic blood pressure, hemoglobin A1c levels, and prescription history of RAS inhibitors, we established a cohort of 58 patients: the SGLT2 inhibitor group (n = 28) and the control group (n = 28). In this cohort, we compared the annual eGFR decline rate between the two groups. The SGLT2 inhibitor group exhibited a significantly smaller eGFR change than the control group (- 1.15 vs. - 2.18 mL/min/1.73 m/year). Within the SGLT2 inhibitor group, patients prescribed RAS inhibitors had demonstrated an even smaller eGFR change (- 0.70 mL/min/1.73 m/year). In conclusion, SGLT2 inhibitors also have safeguarding effects in the stage of diabetic nephropathy without albuminuria, and the combined use of a SGLT2 inhibitor and a RAS inhibitor appears to be more effective than the single use of each.
钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂和肾素-血管紧张素系统（RAS）抑制剂对无蛋白尿的糖尿病肾病的肾脏保护作用尚未得到充分研究。本回顾性队列研究关注的是基线估算肾小球滤过率（eGFR）>30 mL/min/1.73 m 且尿白蛋白与肌酐比值<30 mg/gCr 的 2 型糖尿病患者。在进行倾向评分匹配后，使用年龄、体重指数、收缩压、糖化血红蛋白水平和 RAS 抑制剂处方史等协变量，我们建立了一个包含 58 名患者的队列：SGLT2 抑制剂组（n=28）和对照组（n=28）。在该队列中，我们比较了两组的年 eGFR 下降率。与对照组相比，SGLT2 抑制剂组的 eGFR 变化明显更小（-1.15 与-2.18 mL/min/1.73 m/年）。在 SGLT2 抑制剂组中，同时使用 RAS 抑制剂的患者的 eGFR 变化更小（-0.70 mL/min/1.73 m/年）。总之，SGLT2 抑制剂在无蛋白尿的糖尿病肾病阶段也具有保护作用，并且 SGLT2 抑制剂与 RAS 抑制剂联合使用似乎比单独使用每种药物更有效。
