Gentamicin (GM) is an antibiotic related to aminoglycoside group that is used in treating Gram‐negative bacterial infections. However, treatment with gentamicin is considered to be limited as it induces an oxidative stress‐mediated apoptosis in kidney which causes a nephrotoxicity. Metformin is a well‐known biguanide that is used for treating diabetes mellitus, especially type 2. Supplement with plant metabolites or natural antioxidants produce a protective activity against many types of diseases in vivo. Curcumin is a main medicinal constituent of Curcuma longa, has reported for number of biological effects, such as antioxidant, anti‐inflammatory, and antitumor. The study aims at evaluating the metformin and curcumin alone or in combination on nephrotoxicity induced by GM. The outcome of the study shows that both metformin and curcumin, when used unaided, were effectively decreasing GM‐induced nephrotoxicity. The two drugs combination was showed synergistic effect in ameliorating a GM‐induced kidney injury, as supported by expressively improved renal dysfunction. Metformin and curcumin showed strong protection against oxidative stress in GM treated animals through decreasing the activities and expression of various antioxidative enzymes. Moreover, combination of two drugs showed an anti‐inflammatory response through reducing a level of pro‐inflammatory cytokines including tumor necrosis factor‐alpha, interleukin 1‐beta, and interleukin 6 in GM intoxicated group of animals. Furthermore, GM agitated apoptosis was affectedly diminished by the combinational treatment of metformin and curcumin via down‐regulating activity of cleaved Caspase‐3 and pro‐apoptotic factor Bax, whereas increasing anti‐apoptotic factor Bcl‐2 signaling pathways. The above results suggested that combinational treatment of metformin and curcumin might be have a synergizing effect and substantial potential against nephrotoxicity induced by GM. Practical applications Curcumin and metformin combination exhibited substantial synergistic effect against GM‐induced nephrotoxicity through reducing oxidative stress, inflammation, as well as apoptosis in kidney cells. Therefore, the method of combination of curcumin and metformin might be functional to treat or inhibit GM prompted nephrotoxicity in future.

Introduction: Previous studies suggested that sevelamer carbonate is well tolerated with a favorable efficacy and safety profile in both dialysis and nondialysis patients in Europe; however, the efficacy remains controversial, and few studies have examined sevelamer carbonate therapy in other ethnic nondialysis CKD patients. This study assessed the efficacy and safety of sevelamer carbonate in Chinese nondialysis CKD patients with hyperphosphatemia. Methods: The multicenter, randomized, double-blind, parallel group, placebo-controlled, and phase 3 clinical trial enrolled 202 Chinese nondialysis CKD patients with serum phosphorus ≥1.78 mmol/L. Patients were randomly assigned 1:1 to receive sevelamer carbonate (2.4-12 g per day) or placebo for 8 weeks. The primary outcome was the change in serum phosphorous between baseline and week 8. Results: Totally 482 Chinese patients were screened and 202 were randomized (sevelamer carbonate, n=101; placebo, n=101). The mean serum phosphorous decreased significantly in patients treated with sevelamer carbonate compared with placebo (-0.22±0.47 vs. 0.05±0.44 mmol/L, p<0.0001). Significantly (p<0.0001) decreases of serum total cholesterol, low-density lipoprotein cholesterol and calcium-phosphorus (Ca × P) product levels from baseline to week 8 were shown in sevelamer carbonate group compared with placebo group. Serum intact parathyroid hormone (iPTH) was not significantly changed in the sevelamer carbonate group (p=0.83). Patients in the sevelamer carbonate group experienced similar adverse events as the placebo group. Conclusion: Sevelamer carbonate is an effective and well-tolerated phosphate binder in advanced nondialysis CKD Chinese patients with hyperphosphatemia.