| objective: To explore the evidence from randomized controlled trials about the effects of dipeptidyl peptidase-4 inhibitors on renal function indexes and renal prognosis in patients with type 2 diabetes mellitus,and to better define the effect of DPP-4 inhibitors on renal outcome and prognosis in patients with T2 DM.methods: The databases（CNKI,Wanfang,Weipu,CBM,Pub Med,EMBASE,web of science,Cochrane library）were searched by computer,and the time was from the construction of the library to December 1st,2021.The RCT reported at least one renal indicator for the effect of DPP-4 inhibitors（compared with other hypoglycemic drugs or placebos）on patients with T2 DM.The process of literature screening,literature quality evaluation and data extraction was performed by 2researchers independently.The process of meta analysis was done via Review Manage5.3.results: A total of 10,846 literatures were obtained from the preliminary search.After screening by two researchers according to the inclusion and exclusion criteria,a total of 23 literatures were finally included,including 4 Chinese literatures and19 English literatures.All included studies involved a total of 53,271 people;the literature heterogeneity in the e GFR,UACR,creatinine,and glycosylated hemoglobin groups was high,and a random-effects model was used to combine the effect sizes.The risk of new proteinuria,the risk of worsening proteinuria,the occurrence of end-stage renal disease,the occurrence of death due to renal disease,the occurrence of all-cause death,and the occurrence of adverse events were homogeneous,so fixed-effects models were used to combine them.Effect size,the results of meta-analysis showed that the e GFR level of the DPP-4 inhibitor group in T2 DM patients was lower than that of the control group,and the difference was statistically significant,[WMD=-1.32,95%CI（-2.00,-0.63）,P=0.0002 ];Compared with the control group,the level of UACR in the DPP-4 inhibitor group [WMD=-0.76,95%CI（-3.29,1.76）,P=0.55],the difference was not statistically significant;the risk of new proteinuria was significant lower than the control group [RR=0.88,95%CI（0.80,0.98）,P=0.02],the difference was statistically significant;the risk of worsening proteinuria category was significantly lower than the control group[RR=0.87,95%CI（0.82],0.93）,P<0.00001],with statistical significance;the change of creatinine level was not statistically significant compared with the control group [WMD=-0.98,95%CI（-2.51,0.56）,P=0.21];The incidence of endstage renal disease was compared with the control group [RR=0.94,95%CI（0.79,1.12）,P=0.5],which was not statistically significant;the incidence of death due to renal disease was compared with the control group [RR=1.82,95%] CI（0.67,4.92）,P=0.24],no statistical significance;the occurrence of all-cause death compared with the control group [RR=1.01,95%CI（0.94,1.08）,P=0.76],no statistical significance;The level of glycosylated hemoglobin was lower than that of the control group [WMD=-0.17,95%CI（-0.28,-0.06）,P=0.003],which was statistically significant;the occurrence of adverse events was compared with that of the control group [RR=1.00,95%CI（0.98,1.02）,P=0.82],no statistical significance.conclusions: Compared with placebo or other hypoglycemic agents,DPP-4inhibitors can reduce the occurrence and progression of albuminuria,and may have a certain protective effect on the kidneys.However,DPP-4 inhibitors may be related to the reduction of e GFR,no obvious benefit has been observed in outcome indicators such as UACR,creatinine,end-stage renal disease,risk of adverse reactions,and mortality.Therefore,whether DPP-4 inhibitors can improve the renal prognosis of T2 DM patients remains to be further confirmed by subsequent clinical trials. |
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