Protective Effect Of Dagligin On Renal Function In Patients With Diabetic Nephropathy Complicated With Chronic Kidney Disease At Stage 3a

Background Among hospitalized patients with Chronickidneydisease（CKD）in China,the proportion of Diabeticnephropathy（DN）increases year by year,reaching the first place.Currently,there are no specific drugs for the treatment of diabetic nephropathy.Therefore,actively seeking methods or drugs to delay the progression of diabetic nephropathy is of great significance for reducing the occurrence of end-stage renaldisease（ESRD）,improving the survival rate of patients and improving the prognosis of diabetic patients.As a hypoglycemic drug,in addition to its safe hypoglycemic effect,many studies have confirmed that dagliazine has a renal protective effect on the basis of controlling blood sugar.At home and abroad about the net up to Glenn kidney research direction mainly based on renal function in patients with normal or mildly impaired renal function,and estimated glomerular filtration rate(（estimatedglomerularfiltrationrate,e GFR）≥60ml·min^-1·（1.73m²）^-1)of diabetic nephropathy.Dagliazine targets the kidney,and its efficacy and safety in patients with moderately impaired renal function are unknown.Therefore,it is of great clinical significance to further study the efficacy of Dagliazine in patients with chronic renal disease stage 3a whose renal function has been impaired.Objective（1）Further confirmed the protective effect of Dapagliflozin on renal function in patients with diabetic nephropathy complicated with chronic kidney disease at stage 3a.（2）Dapagliflozin has no obvious adverse reaction in patients with diabetic nephropathy complicated with chronic kidney disease for three years,and its safety is good.Methods Patients with diabetic nephropathy complicated with chronic renal disease stage3a at the Department of Nephrology and Endocrinology of the First People’s Hospital of Yichang City from December 1,2020 to December 1,2022 were selected,conforming to the1999 WHO diagnostic criteria for diabetes,as well as type 2 diabetes mellitus,T2DM)diagnostic criteria and estimated glomerular filtration rate of（e GFR）45ml·min^-1·（1.73m²）^-1～59ml·min^-1·（1.73m²）^-1,severe hepatic and renal function abnormalities were excluded.Severe cardiovascular and cerebrovascular diseases;Diabetic ketoacidosis,diabetic hypertonic coma and other acute diabetic complications;Malignant tumor;Infectious diseases;Patients with a history of SGLT-2i medication.A total of 120 patients,aged between 18 and 65 years old,were divided into control group and observation group according to whether Dapagliflozin was used or not,with 60 cases in each group,including 60 patients in control group（32 males,28 females）,average age（58.6±4.93）,60 patients in observation group（31 males,29females）.The mean age was（57.9±4.47）.The two groups had strict low salt,low fat,high quality low protein diet,diabetic diet and appropriate exercise.The control group was also given comprehensive treatment including hypoglycemic（oral hypoglycemic drugs or subcutaneous insulin injection）,antihypertensive,lipid-regulating,anti-platelet aggregation,control of uric acid level and improvement of circulation.Observation group was additionally given oral Dapagliflozin tablets,10mg/time,once a day on the basis of control group.Basic information such as name,age,gender,height and weight of the two groups were recorded.Previous history,such as years of medical history,smoking,drinking,etc.and general test indicators,such as:Blood pressure（BP）,body massindex（BMI）,blood glucose,glycosylated hemoglobin（Hb A1c）,serum creatinine（Scr）,estimated glomerular filtration rate（e GFR）,urinary microalbumin/creatinine ratio（UACR）,blood uric acid（UA）,hypersensitive C-reactive protein（hs-CRP）,etc.Results（1）There were no statistically significant differences in age,gender,BMI,blood glucose,glycosylation,creatinine value,glomerular filtration rate,urinary microalbumin/creatinine ratio,blood uric acid and hypersensitive C-reactive protein between the two groups before enrollment（P>0.05）,indicating that the two groups were comparable.（2）Comparison of blood glucose and glycosylation between the two groups:the fasting blood glucose and glycosylation of patients in the observation group were significantly improved after the use of Dapagliflozin（P<0.05）,and were significantly improved after 6months.The blood glucose value of the observation group was significantly lower than that of the control group,and the glycosylation effect was more obvious after 12 months of treatment with Dapagliflozin.（3）Comparison of renal function between the two groups:the creatinine value,glomerular filtration rate and urinary microalbumin/creatinine ratio in the observation group were better than those in the control group,while the creatinine and microalbumin were significantly decreased（P<0.05）,and the glomerular filtration rate was higher than that in the control group.（4）After treatment,the two groups of patients with inflammation index hs-CRP comparison:observation group is significantly better than control group;hs-CRP decreased to a certain extent（P>0.05）.（5）Comparison of electrolyte indexes potassium,calcium,phosphorus and blood uric acid:There were no significant differences in electrolyte level（potassium,calcium,phosphorus）and blood uric acid between the two groups after treatment（P>0.05）.（6）adverse reactions:during the treatment of the two groups,there were 7 patients with hypoglycemia（5 cases in the control group and 2 cases in the observation group）,1 case of hypotension in the observation group,and 5 cases of urinary system infection in the observation group（2 cases in the control group 3 cases in the observation group）.There was no significant difference in the incidence of adverse reactions between the observation group and the control group,and the difference was not statistically significant（P>0.05）.Conclusion（1）Dapagliflozin has protective effect on renal function of patients with diabetic nephropathy complicated with chronic kidney disease in stage 3a.（2）On the premise that there is no obvious difference in baseline between the two groups,after 6 months and 12 months of treatment,the patients in the observation group have no obvious adverse reactions compared with the control group,and the safety is better.