膳食钠和蛋白质摄入对钠-葡萄糖共转运蛋白2抑制剂治疗2型糖尿病患者肾小球滤过率的影响

IF 1.6 4区 医学 Q4 ENDOCRINOLOGY & METABOLISM Experimental and Clinical Endocrinology & Diabetes Pub Date : 2023-05-01 DOI:10.1055/a-2041-1516
Costanza Gaudio, Marta Seghieri, Chiara Merciai, Claudia Colombi, Giuseppe Spatoliatore, Cristiana Maria Baggiore, Alberto Rosati
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引用次数: 0

摘要

背景:大约四分之一接受钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)治疗的患者急性肾小球滤过率(eGFR)估计降低超过10%(“下降”)。高钠和高蛋白质摄入可增加肾小球内压,易导致肾功能下降。我们研究了测量肌酐清除率(CrCl)是否是一种足够灵敏的方法来检测GFR的初始下降,以及饮食钠和蛋白质摄入量是否可能影响GFR的早期变化程度。方法:纳入28例2型糖尿病(T2D)患者。对于钠和尿素的测定,收集24小时尿液样本,分别估算SGLT2i开始前和开始后1、3和6个月的钠和蛋白质摄入量。结果:平均CrCl为83.23±25.52 mL/min/1.73 m2 (eGFR 67.32±16.07),第1个月下降19% (eGFR下降6%)。根据CrCl和eGFR,下降率分别为64%和40%。探索肾功能变化与盐摄入量之间的潜在相关性,ΔCrCl和基线尿钠在第1个月呈负相关(r=-0,61;公关= -0.51;P =0.01)和第6个月(r=-0,48;公关= -0.46;公关= -0.47;p = 0.054)。结论:本研究表明,在接受SGLT2i治疗的糖尿病患者中,较高的饮食钠和蛋白质摄入量可能会放大GFR早期下降的程度,正如测量的CrCl所检测的那样。
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Effects of Dietary Sodium and Protein Intake on Glomerular Filtration Rate in Subjects with Type 2 Diabetes Treated with Sodium-Glucose Cotransporter 2 Inhibitors.

Background: Approximately one-fourth of patients treated with sodium-glucose cotransporter 2 inhibitors (SGLT2i) experience an acute estimated glomerular filtration rate (eGFR) reduction of more than 10% ("dippers"). High sodium and protein intake can increase intraglomerular pressure and predispose to a decline in renal function. We investigated whether measured creatinine clearance (CrCl) is a sensitive enough method to detect the initial dip of GFR and if dietary sodium and protein intake might influence the extent of the early change in GFR.

Methods: 28 subjects with type 2 diabetes (T2D) were enrolled. For sodium and urea determination, 24-h urinary samples were collected to estimate sodium and protein intake respectively before and 1, 3 and 6 months after SGLT2i initiation.

Results: Mean CrCl was 83.23±25.52 mL/min/1.73 m2 (eGFR 67.32±16.07) and dropped by 19% at month 1 (eGFR by 6%). Dippers were 64 and 40%, according to CrCl and eGFR, respectively. Exploring the potential correlation between changes in renal function and salt intake, ΔCrCl and baseline urinary sodium were inversely related at month 1 (r=-0,61; p<0.01), at month 3 (r=-0.51; p=0.01) and month 6 (r=-0,48; p<0.05). Likewise, an inverse correlation between ΔCrCl and baseline urinary urea was demonstrated at months 1 and 3 (r=-0.46; p<0.05 for both); at month 6, a similar trend was observed (r=-0.47; p=0.054).

Conclusions: The present study suggests that a higher dietary sodium and protein intake may amplify the extent of the early dip in GFR, as detected with measured CrCl, in diabetic patients undergoing SGLT2i treatment.

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来源期刊
CiteScore
4.10
自引率
5.60%
发文量
72
审稿时长
3 months
期刊介绍: Publishing outstanding articles from all fields of endocrinology and diabetology, from molecular biology to clinical research, this journal is a brilliant resource. Since being published in English in 1983, the popularity of this journal has grown steadily, reflecting the importance of this publication within its field. Original contributions and short communications appear in each issue along with reviews addressing current topics. In addition, supplementary issues are published each year presenting abstracts or proceedings of national and international scientific meetings. The journal was initially published in German and is still the oldest endocrinological periodical in the German-language market!
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