ABSTRACT
BACKGROUND: Type 2 diabetes causes cardio-renal complications and is treated with different combination therapies. The renal hemodynamics profile of such combination therapies has not been evaluated in detail. METHODS: Patients (N = 97) with type 2 diabetes were randomized to receive either empagliflozin and linagliptin (E+L group) or metformin and insulin glargine (M+I group) for 3 months. Renal hemodynamics were assessed with para-aminohippuric acid and inulin for renal plasma flow (RPF) and glomerular filtration rate (GFR). Intraglomerular hemodynamics were calculated according the Gomez´ model. RESULTS: Treatment with E+L reduced GFR (p = 0.003), but RPF remained unchanged (p = 0.536). In contrast, M+I not only reduced GFR (p = 0.001), but also resulted in a significant reduction of RPF (p < 0.001). Renal vascular resistance (RVR) decreased with E+L treatment (p = 0.001) but increased with M+I treatment (p = 0.001). The changes in RPF and RVR were different between the two groups (both padjust < 0.001). Analysis of intraglomerular hemodynamics revealed that E+L did not change resistance of afferent arteriole (RA) (p = 0.116), but diminished resistance of efferent arterioles (RE) (p = 0.001). In M+I group RA was increased (p = 0.006) and RE remained unchanged (p = 0.538). The effects on RA (padjust < 0.05) and on RE (padjust < 0.05) differed between the groups. CONCLUSIONS: In patients with type 2 diabetes and preserved renal function treatment with M+I resulted in reduction of renal perfusion and increase in vascular resistance, in contrast to treatment with E+I that preserved renal perfusion and reduced vascular resistance. Moreover, different underlying effects on the resistance vessels have been estimated according to the Gomez model, with M+I increasing RA and E+L predominantly decreasing RE, which is in contrast to the proposed sodium-glucose cotransporter 2 inhibitor effects. TRIAL REGISTRATION: The study was registered at www.clinicaltrials.gov (NCT02752113) on April 26, 2016.
Subject(s)
Benzhydryl Compounds/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Diabetic Nephropathies/prevention & control , Dipeptidyl-Peptidase IV Inhibitors/therapeutic use , Glucosides/therapeutic use , Hemodynamics/drug effects , Hypoglycemic Agents/therapeutic use , Insulin Glargine/therapeutic use , Linagliptin/therapeutic use , Metformin/therapeutic use , Renal Plasma Flow/drug effects , Sodium-Glucose Transporter 2 Inhibitors/therapeutic use , Aged , Benzhydryl Compounds/adverse effects , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/diagnosis , Diabetic Nephropathies/diagnosis , Diabetic Nephropathies/etiology , Diabetic Nephropathies/physiopathology , Dipeptidyl-Peptidase IV Inhibitors/adverse effects , Drug Therapy, Combination , Female , Germany , Glomerular Filtration Rate/drug effects , Glucosides/adverse effects , Humans , Hypoglycemic Agents/adverse effects , Insulin Glargine/adverse effects , Linagliptin/adverse effects , Male , Metformin/adverse effects , Middle Aged , Prospective Studies , Sodium-Glucose Transporter 2 Inhibitors/adverse effects , Time Factors , Treatment OutcomeABSTRACT
Este artículo presenta el mapa de los residuos patogénicos de la ciudad de Buenos Aires y el Conurbano Bonaerense
Subject(s)
Argentina , Medical Waste , Hazardous Waste Minimization , Costs and Cost AnalysisABSTRACT
Este artículo presenta el mapa de los residuos patogénicos de la ciudad de Buenos Aires y el Conurbano Bonaerense