钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 对心力衰竭 (HF) 患者的肾功能有有利的影响，但没有明确的证据表明哪些因素可以预测这种影响。该研究的目的是确定 HF 患者肾功能结果的合理预测因素，并调查其与 SGLT2i 的关联。我们前瞻性地招募了 480 名接受饮食和二甲双胍治疗并伴有慢性 HF 的 2 型糖尿病 (T2DM) 患者，并对他们进行随访52 周。在这项研究中，我们将肾脏结果确定为估计肾小球滤过率较基线降低 40%、新诊断的终末期肾病或肾脏替代治疗的综合结果。在基线和研究结束时收集相关医学信息和生物标志物（N端利尿钠前肽、鸢尾素、apelin、adropin、C反应蛋白、肿瘤坏死因子-α）的测量结果。复合肾在整个人群中 88 名 (18.3%) 患者中检测到结果。所有患者均接受指南推荐的最佳治疗，并根据心力衰竭的表型/严重程度、心血管风险和合并症情况以及空腹血糖进行调整。在没有临床终点的患者中，鸢尾素、adropin 和 apelin 的水平显着升高，而在具有复合终点的患者中，生物标志物水平则表现出下降，具有临界统计显着性（p = 0.05）。我们注意到，基线时鸢尾素 ≤ 4.50 ng/ml 和鸢尾素血清水平 ≤ 15% 的增加比参考变量增加了更有价值的预测信息。然而，基线时鸢尾素 ≤ 4.50 ng/ml 和鸢尾素血清水平 ≤ 15% 增加（曲线下面积 = 0.91；95% 置信区间 = 0.87-0.95）相结合，单独提高了每种生物标志物的判别价值。低水平的鸢尾素及其在 SGLT2i 给药期间的不充分增加是 T2DM 合并心力衰竭患者肾脏结局不良的有希望的预测因子。© 2023。作者。

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have a favorable impact on the kidney function in patients with heart failure (HF), while there is no clear evidence of what factors predict this effect. The aim of the study was to identify plausible predictors for kidney function outcome among patients with HF and investigate their association with SGLT2i.We prospectively enrolled 480 patients with type 2 diabetes mellitus (T2DM) treated with diet and metformin and concomitant chronic HF and followed them for 52 weeks. In the study, we determined kidney outcome as a composite of ≥ 40% reduced estimated glomerular filtration rate from baseline, newly diagnosed end-stage kidney disease or kidney replacement therapy. The relevant medical information and measurement of the biomarkers (N-terminal natriuretic pro-peptide, irisin, apelin, adropin, C-reactive protein, tumor necrosis factor-alpha) were collected at baseline and at the end of the study.The composite kidney outcome was detected in 88 (18.3%) patients of the entire population. All patients received guideline-recommended optimal therapy, which was adjusted to phenotype/severity of HF, cardiovascular risk and comorbidity profiles, and fasting glycemia. Levels of irisin, adropin and apelin significantly increased in patients without clinical endpoint, whereas in those with composite endpoint the biomarker levels exhibited a decrease with borderline statistical significance (p = 0.05). We noticed that irisin ≤ 4.50 ng/ml at baseline and a ≤ 15% increase in irisin serum levels added more valuable predictive information than the reference variable. However, the combination of irisin ≤ 4.50 ng/ml at baseline and ≤ 15% increase in irisin serum levels (area under curve = 0.91; 95% confidence interval = 0.87-0.95) improved the discriminative value of each biomarker alone.We suggest that low levels of irisin and its inadequate increase during administration of SGLT2i are promising predictors for unfavorable kidney outcome among patients with T2DM and concomitant HF.© 2023. The Author(s).