关键词:

糖尿病, 慢性肾脏病, 非奈利酮, SGLT2抑制剂, 心肾结局

Abstract:

Objective　To explore the effect of fineridone combined with sodium-dependent glucose transporters 2 (SGLT2) inhibitor on cardiorenal outcomes in diabetes mellitus complicated with chronic kidney disease (CKD) patients. Methods　This study was a prospective study. A total of 82 patients with diabetes and CKD who were treated at the Second Affiliated Hospital of Xi'an Medical University from March 2022 to March 2024 were selected for this study. They were randomly divided into a control group and a study group, with 41 cases in each group, using the envelope method. The control group consisted of 24 males and 17 females, with an average age of (58.22±6.55) years. The study group included 22 males and 19 females, with an average age of (59.02±6.44) years. The control group received SGLT2 inhibitor (dapagliflozin) plus placebo (starch tablets simulating Finerenone), while the study group received SGLT2 inhibitor (dapagliflozin) combined with Finerenone. Both groups were treated continuously for 3 months. Clinical efficacy, laboratory indicators of cardiovascular and renal function before and after treatment, and cardiovascular and renal outcomes were compared. Statistical analysis was performed using t tests, χ² tests, and Fisher's exact probability method. Results　The overall clinical effective rate in the study group was higher than that in the control group [95.12% (39/41) vs. 80.49% (33/41)], with a statistically significant difference (χ²=4.100, P=0.043). After treatment, levels of brain natriuretic peptide, urinary albumin excretion rate, and blood urea nitrogen in the study group were lower than those in the control group [(142.63±28.74) ng/L vs. (210.26±38.78) ng/L; (98.52±18.63) mg/24 h vs. (130.85±25.63) mg/24 h; (7.22±2.01) mmol/L vs. (9.18±2.37) mmol/L], with all differences being statistically significant (t=8.971, 6.533, 4.039; all P<0.001). The incidence of the primary endpoint in the study group was lower than that in the control group [9.76% (4/41) vs. 26.83% (11/41)] (χ²=3.998, P=0.046), with 2 cardiovascular events and 2 renal events in the study group, compared to 7 cardiovascular events and 4 renal events in the control group. The incidence of newly developed proteinuria in the study group was lower than that in the control group [4.88% (2/41) vs. 19.51% (8/41)] (χ²=4.100, P=0.043). There were no statistically significant differences in all-cause mortality, hyperkalemia incidence, and drug safety between the two groups (all P>0.05). Conclusion　The combination of finerenone and SGLT2 inhibitor in patients with diabetes and CKD can enhance clinical efficacy, improve cardiac and renal functions, and optimize cardiac and renal outcomes, making it worthy of promotion and application.

Key words:

Diabetes mellitus, Chronic kidney disease, Finerenone, SGLT2 inhibitor, Cardiorenal outcomes