Ngai Andrew W, Baig Aqsa, Zia Muhammad, Arca-Contreras Karen, Haque Nadeem Ul, Livetsky Veronica, Rokicki Marcelina, Sukhram Shiryn D
Department of Biology, College of Staten Island, City University of New York, 2800 Victory Boulevard, Building 6S, Staten Island, NY 10314, USA.
Department of Environmental and Public Health Sciences, University of Cincinnati, 160 Panzeca Way, Kettering Lab Building, Cincinnati, OH 45267, USA.
Int J Mol Sci. 2025 Aug 1;26(15):7412. doi: 10.3390/ijms26157412.
Diabetic nephropathy affects approximately 30-40% of individuals with diabetes mellitus (DM) and is a major contributor to end-stage renal disease (ESRD). While angiotensin II receptor blockers (ARBs) have long served as a standard treatment, sodium-glucose cotransporter-2 inhibitors (SGLT2i) have recently gained attention for their renal and cardiovascular benefits. However, comparative real-world data on their long-term renal effectiveness remain limited. We conducted a retrospective, longitudinal study over a 2-year period to compare the impact of ARB monotherapy versus SGLT2i and angiotensin-converting enzyme inhibitor (ACEi) combination therapy on the progression of chronic kidney disease (CKD) in patients with DM. A total of 126 patients were included and grouped based on treatment regimen. Renal biomarkers were analyzed using -tests and ANOVA ( < 0.01). Albuminuria was qualitatively classified via urinalysis as negative, level 1 (+1), level 2 (+2), or level 3 (+3). The ARB group demonstrated higher estimated glomerular filtration rate (eGFR) and lower serum creatinine (sCr) levels than the combination therapy group, with glycated hemoglobin (HbA1c), potassium (K), and blood pressure remaining within normal limits in both cohorts. Albuminuria remained stable over time, with 60.8% of ARB users and 73.1% of combination therapy users exhibiting persistently or on-average negative results. Despite the expected additive benefits of SGLT2i/ACEi therapy, ARB monotherapy was associated with slightly more favorable renal function markers and a lower incidence of severe albuminuria. These findings suggest a need for further controlled studies to clarify the comparative long-term renal effects of these treatment regimens.
糖尿病肾病影响着约30%-40%的糖尿病患者，是终末期肾病（ESRD）的主要成因。虽然血管紧张素II受体阻滞剂（ARB）长期以来一直是标准治疗药物，但钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）最近因其对肾脏和心血管的益处而受到关注。然而，关于它们长期肾脏疗效的比较性真实世界数据仍然有限。我们进行了一项为期2年的回顾性纵向研究，以比较ARB单药治疗与SGLT2i和血管紧张素转换酶抑制剂（ACEi）联合治疗对糖尿病患者慢性肾脏病（CKD）进展的影响。共纳入126例患者，并根据治疗方案进行分组。使用t检验和方差分析（<0.01）分析肾脏生物标志物。通过尿液分析将蛋白尿定性分为阴性、1级（+1）、2级（+2）或3级（+3）。与联合治疗组相比，ARB组的估计肾小球滤过率（eGFR）更高，血清肌酐（sCr）水平更低，两个队列中的糖化血红蛋白（HbA1c）、钾（K）和血压均保持在正常范围内。随着时间的推移，蛋白尿保持稳定，60.8%的ARB使用者和73.1%的联合治疗使用者表现出持续或平均为阴性的结果。尽管SGLT2i/ACEi治疗预期有累加益处，但ARB单药治疗与略更有利的肾功能指标和更低的严重蛋白尿发生率相关。这些发现表明需要进一步的对照研究来阐明这些治疗方案的比较性长期肾脏效应。
