Abstract
Introduction: Diabetic nephropathy (diabetic kidney disease) is a complication of diabetes that begins and progresses with several factors, including hyperglycemia, inflammation and oxidative stress. Objective: This study demonstrates the effect of sevelamer carbonate administration on hemoglobin A1c levels, blood sugar and inflammatory factors in diabetic nephropathy patients. Patients and Methods: In this clinical trial, 48 diabetic patients under treatment of least one drug who have proteinuria (urinary protein to creatinine ratio greater than 0.5) ≥ 2 times during the past 18 months, received sevelamer carbonate or placebo for two months. Patients’ blood samples were taken before and after the intervention. Data were analyzed by SPSS software. Results: According to the results, fasting blood sugar (FBS), hemoglobin A1c (HbA1c), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) showed no significant difference between the study groups before and after the intervention (P>0.05). The mean ICAM-1(intercellular adhesion molecule-1) and VCAM-1 (vascular cell adhesion molecule1) showed no significant difference between the study groups before the intervention (P>0.05). However we found a meaningful difference after the intervention, which was significantly lower in the intervention group (P<0.05). Conclusion: Sevelamer carbonate administration in patients with diabetic nephropathy has a significant effect on decreasing ICAM-1 and VCAM-1 levels. Trial registration: The trial protocol was approved in the Iranian Registry of Clinical Trial (identifier: IRCT20191111045401N1; https://en.irct.ir/trial/43662, ethical code; IR.SKUMS. REC.1397.181).
Highlights
Diabetic nephropathy is a complication of diabetes that begins and progresses with several factors, including hyperglycemia, inflammation and oxidative stress
Treatment of diabetic nephropathy patients with sevelamer carbonate led to a significant decrease of ICAM-1 and VCAM-1 adhesion molecules which suggests the role of sevelamer carbonate in the recovery of endothelial dysfunction
Regarding the blood sugar decreasing effect of sevelamer carbonate and on micro-inflammation, this study aimed to investigate the effect of sevelamer carbonate on hemoglobin A1c (HbA1c), blood sugar and inflammatory factors in patients with diabetic nephropathy
Summary
Diabetic nephropathy (diabetic kidney disease) is a complication of diabetes that begins and progresses with several factors, including hyperglycemia, inflammation and oxidative stress. Objective: This study demonstrates the effect of sevelamer carbonate administration on hemoglobin A1c levels, blood sugar and inflammatory factors in diabetic nephropathy patients. Results: According to the results, fasting blood sugar (FBS), hemoglobin A1c (HbA1c), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) showed no significant difference between the study groups before and after the intervention (P > 0.05). Conclusion: Sevelamer carbonate administration in patients with diabetic nephropathy has a significant effect on decreasing ICAM-1 and VCAM-1 levels. Advanced glycation end products (AGEs) play a major role in these risk factors; since they cause both inflammation and oxidative stress [4]. The finding has been approved by studies in which, using foods containing high levels of AGE has caused insulin resistance, increased inflammation and decreased antioxidant immune system [6,7]
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