Efficacy and safety of combined cardio-nephroprotective therapy in patients with chronic kidney disease stages 3-4

Objective: To study the efficacy and safety of combined cardio-nephroprotective therapy in patients with chronic kidney disease stages 3-4. Materials and Methods: The prospective study included 158 patients with chronic kidney disease stages C3a-C4, estimated glomerular filtration rate of 15-59 ml/min/1.73 m2, type 2 diabetes mellitus and/or chronic heart failure. Participants were divided into two groups: the first (n=79) received sodium-glucose cotransporter-2 inhibitors (SGLT2i): dapagliflozin or empagliflozin 10 mg/day, in combination with atorvastatin 40 mg/day; the second group (n=79) received standard therapy. Results: In the combination therapy group, the glomerular filtration rate stabilized (Δ +0.9 ml/min/1.73 m2; 95% CI -0.5; 2.3). In the control group, on the contrary, its decrease was observed (Δ -2.3 ml/min/1.73 m2; 95% CI -3.8; -0.8; p=0.014). A decrease in the urine albumin to creatinine ratio by 47.6% (p<0.001) was also recorded. Global longitudinal strain of the myocardium improved: from 15.8% to 17.2% (p<0.001). In the combination therapy group, 73.4% of patients achieved the target low-density lipoprotein cholesterol level of less than 1.8 mmol/L. In the control group, this figure was achieved in only 39.2% of patients (p<0.001). Combination therapy reduced the risk of cardiorenal outcomes by 60% (relative risk 0.40; 95% CI 0.16-0.98; p=0.047) and was characterized by a favorable safety profile without an increase in the incidence of serious adverse events. Conclusions: The use of SGLT2i in combination with high-intensity statin therapy in patients with chronic kidney disease stages 3-4 has a significant nephro- and cardioprotective effect, promotes effective correction of the lipid profile and has a favorable safety profile.