examination of the effects of liraglutide on diabetic nephropathy

Abstract

Body Cell Mass (BCM) is a sum of all metabolically active cells of the body. Aim of the study was to compare BCM with other nutritional and inflammatory markers in patients with chronic kidney disease (CKD) stage 4-5 (NKF) without dialysis treatment and in hemodialysis patients(HD). We included 45 adult patients with CKD and eGFR o30 ml/min not treated with dialysis (26 male, age: 59,7 7 16,8) and 39 adults treated with HD three times a week, for more than three months (26 male, 5 diabetics, age: 59,8 716). Body composition was measured using multifrequency biopimpedance spectroscopy: Body Composition Monitor -FMC. We used BCM index (BCMI) defined as BCM divided by height to the power of 2. To measure hand grip strength (HGS) we used dynamometr Jamar. In statistics analysis we used Pearson correlations (SPSS v18). Predialysis group: BCMI: 7,1 7 1,6 kg/m 2 , Lean Tissue Index (LTI): 12,9 7 2,4 kg/m 2 , Fat Tissue Index (FTI): 14,7 7 5,4 kg/m 2 , BMI: 28,2 7 5 kg/m 2 , serum creatinine level (SCr): 3,9 7 2,1 mg/dl, eGFR: 18,3 77,0034 ml/min/1,73 m 2 , albumin (SA): 3,9 7 0,3 g/dl, prealbumin (PA): 32,8 78,8 mg/dl, CRP: 0,5 7 0,3 mg/dl. A positive correlation was found with BCMI and HGS (r ¼ 0,55; p ¼0,001), PA (r ¼ 0,41; p ¼0,004) and SCr (r ¼ 0,37; p ¼0,012). A negative correlation was found between BCMI and age (r ¼ -0,48; p¼0,006), CRP (r ¼ -0,33; p¼ 0,028). We do not observed correlation with BMI and SA. HD group: BCMI: 6,4 7 1,7 kg/m 2 , LTI: 12,1 7 2,3 kg/m 2 , FTI: 12 7 6 kg/m 2 , BMI: 24,8 7 4,8, SCr: 8,9 7 2,6 mg/dl, TP: 6,7 7 0,6 g/dl, SA: 3,9 7 0,47 g/dl, PA 33,8 7 11,4 g/dl, CRP: 1,1 7 1,4 mg/dl. A positive, significant correlation was found between BCMI and HGS (r ¼ 0,47; p¼ 0,003). A negative correlation was found with BCMI and age (r ¼ -0,55; p¼0,0005) and with CRP (r ¼ -0,31), but not statistically significant. We do not observed correlation between BCMI and BMI, SCr, TP, SA, PA, hemodialysis vintage, Kt/V. Assessment of body compartments is important tool in estimation nutritional status in patients with stage IV-V CKD and hemodialysis patients. Analysis of body composition in association with other markers worth to be studied, especially in larger groups of patients.

Linagliptin Lowers Albuminuria on Top of Recommended Standard Treatment in Patients With Type 2 Diabetes and Renal Dysfunction

“…Despite a significant improvement in HbA 1c from baseline (by −0.8% [−8.7 mmol/mol]) at the end of the study, sitagliptin was associated with an increase in UACR from baseline by +18 and +6% after 24 and 54 weeks of treatment, respectively ( 23 ). In another study using an injectable GLP-1 analog, Ryuge et al ( 24 ) found that liraglutide was not associated with any changes in renal function or albuminuria after 24 weeks of treatment in patients with diabetic nephropathy. However, these data must be interpreted with caution because both studies provide observational assessments of renal parameters and were not designed specifically to assess changes in albuminuria ( 23 , 24 ).…”

“…In another study using an injectable GLP-1 analog, Ryuge et al ( 24 ) found that liraglutide was not associated with any changes in renal function or albuminuria after 24 weeks of treatment in patients with diabetic nephropathy. However, these data must be interpreted with caution because both studies provide observational assessments of renal parameters and were not designed specifically to assess changes in albuminuria ( 23 , 24 ). Prospective, randomized, controlled clinical trials are now needed to assess the renal effects of incretin-based therapies in patients with type 2 diabetes.…”

“…These results occurred independent of any changes in glucose metabolism because the β-cell response to linagliptin was alleviated as a result of previous administration of streptozotocin, a β-cell toxin, to these mice ( 16 ). However, clinical evidence regarding the renal effects of incretin-based therapies in patients with type 2 diabetes is scarce ( 23 , 24 ), and conclusive evidence to translate the findings of animal models to humans has yet to emerge from dedicated randomized clinical trials. Nevertheless, urinary albumin excretion, assessed by the albumin-to-creatinine (Cr) ratio (UACR), is often collected in clinical development programs involving people with diabetes.…”

Role of Liraglutide in a Major Complication of Diabetes: A Critical Review of Clinical Studies

“…After 6 months of liraglutide administration, the blood glucose levels and average HbA1c were significantly reduced, though, no significant changes in kidney function. The outcomes suggested the improvement in glucose metabolism and body mass index reduction without observable changes in kidney function after administration of liraglutide to diabetic nephropathic patients (Ryuge et al 2012). In support of this study, it has been planned to study the effect of liraglutide on proteinuria and the progression of diabetic nephropathy in T2DM patients.…”

The effects of GLP-1 analogues, DPP-4 inhibitors and SGLT2 inhibitors on the renal system

“…Liraglutide was not associated with any changes in renal function after 24 weeks in patients with DN (eGFR <60 mL/min). 70 Sitagliptin, saxagliptin and linagliptin may have the potential for beneficial renal effects. Sitagliptin (50 mg/day) reduced urinary albumin-to-creatinine ratio (UACR: −20.6 mg/g creatinine) after 24 weeks in patients with T2DM; the effect was observed in patients with normo-, micro- and macroalbuminuria.…”