Comparison of effects of Empagliflozin and Linagliptin on renal function and glycaemic control: a double-blind, randomized clinical trial

Renoprotective Action of Linagliptin Among Diabetic Kidney Disease Patients: A Systematic Review and Meta-Analysis

Despite pharmacological and lifestyle changes, hyperglycemia management in type 2 diabetes mellitus patients, combined with a risk for cardio-renal problems, continues to present a significant challenge for doctors. Linagliptin has been found to have a renoprotective effect in diabetic nephropathy patients in recent studies. This systematic review and meta-analysis (SRMA) was conducted to synthesize available information so as to better understand if linagliptin has a renoprotective effect in type 2 diabetes mellitus patients with nephropathy. Three databases were searched from January 2013 to December 2022 to identify all published studies reporting "linagliptin's effect in patients with diabetic nephropathy". Owing to the heterogeneity of the included studies, the authors have employed a random-effects model to examine the data in this meta-analysis. Standardized mean differences (SMD) for continuous outcomes were used to compute effect sizes. The final analysis included five studies. The change in estimated glomerular filtration rate (eGFR) did not show a statistically significant difference between the group on linagliptin and the other group on placebo, at baseline (mean difference = 1.19, p = 0.28), after three months of intervention in the selected three studies (mean difference = 0.51, p = 0.85), and after six months of intervention in the selected two studies (mean difference = 0.72, p = 0.70). The study found that linagliptin did not have a significant renoprotective effect in patients with type 2 diabetes, indicating no substantial benefit in slowing kidney disease progression. For diabetes patients with chronic renal disease, linagliptin may be a helpful renoprotective treatment choice, but in the future, more robust and longer-duration research is warranted to establish the inference.

Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study

BACKGROUND

Hypertension and chronic kidney disease (CKD) pose significant public health challenges, sharing intertwined pathophysiological mechanisms. Prediabetes is recognized as a precursor to diabetes and is often accompanied by cardiovascular comorbidities such as hypertension, elevating the risk of pre-frailty and frailty. Albuminuria is a hallmark of organ damage in hypertension amplifying the risk of pre-frailty, frailty, and cognitive decline in older adults. We explored the association between albuminuria and cognitive impairment in frail older adults with prediabetes and CKD, assessing cognitive levels based on estimated glomerular filtration rate (eGFR).

METHODS

We conducted a study involving consecutive frail older patients with hypertension recruited from March 2021 to March 2023 at the ASL (local health unit of the Italian Ministry of Health) of Avellino, Italy, followed up after three months. Inclusion criteria comprised age over 65 years, prior diagnosis of hypertension without secondary causes, prediabetes, frailty status, Montreal Cognitive Assessment (MoCA) score < 26, and CKD with eGFR > 15 ml/min.

RESULTS

237 patients completed the study. We examined the association between albuminuria and MoCA Score, revealing a significant inverse correlation (r: 0.8846; p < 0.0001). Subsequently, we compared MoCA Score based on eGFR, observing a significant difference (p < 0.0001). These findings were further supported by a multivariable regression analysis, with albuminuria as the dependent variable.

CONCLUSIONS

Our study represents the pioneering effort to establish a significant correlation between albuminuria and eGFR with cognitive function in frail hypertensive older adults afflicted with prediabetes and CKD.