Abstract
Introduction: Diabetic nephropathy is a main cause of chronic kidney disease (CKD) throughout the world, which requiring early detection and management. Anti-diabetic medications, like sodium-glucose cotransporter-2 (SGLT2) inhibitors, metformin, dipeptidyl peptidase-4 (DPP-4) inhibitors, and sulfonylurea compounds have determined various kidney protective efficacies; nevertheless, their effects on renal biomarkers remained disputing.
Objectives: This study intended to assess renal function biomarkers, regarding anti-diabetic consumption, providing insights into their usefulness for risk categorization and management decision-making in diabetic nephropathy.
Patients and Methods: This cross-sectional investigation, conducted in Basra Governorate, Iraq (October 2024–January 2025) with ethical approval from Basra University’s College of Pharmacy, enrolled participants to evaluate renal function biomarkers across antidiabetic medication regimens. Demographic and clinical data, including age, body mass index, gender, diabetes duration, hypertension status, and treatment regimen like metformin, sulfonylurea, DPP-4 inhibitors and SGLT-2 inhibitors, or combination therapies were gathered by interviews and clinical document reviews. In this study, fasting blood samples were analyzed for kidney function biomarkers, comprising serum creatinine, urea, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR). The study outcomes comprised comparing renal function biomarkers among antidiabetic medication regimens.
Results: The study population comprised of 250 diabetes mellitus individuals (50.8% female) with a mean age of 55.67 ± 8.58 years. The findings showed considerable alterations of BUN, creatinine, urea and eGFR among the five groups. The individuals who received DPP-4 inhibitors had significantly higher BUN and urea levels than individuals treated with metformin or sulfonylurea monotherapy and higher serum creatinine concentration compared to metformin monotherapy, sulfonylurea monotherapy and combination therapy. Regarding eGFR, the DPP-4 inhibitor users had considerably lower value compared to all the other groups, both in metformin monotherapy, sulfonylurea monotherapy, and SGLT-2 inhibitor groups and also in patients under combination therapy.
Conclusion: We found that the consequences of the antidiabetic drug therapy on kidney function are not the same. This study showed that DPP-4 cases had early indications of diminished kidney function than the individuals receiving metformin, sulfonylurea, SGLT-2, or a combination of them. This finding focuses on the importance of considering the potential impact on renal health in cases of selecting diabetes treatments.