Prognostic Factors of Diabetic Kidney Disease and Therapeutic Effects of Shenyuan Granules: A Real-World Prospective Cohort Study

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Background: The aim of this study was twofold: (1) to explore risk factors contributing to the progression of diabetic kidney disease (DKD) and the occurrence of renal and cardiovascular endpoint events in a real-world setting, and (2) to evaluate the effectiveness of Shenyuan Granules, a Chinese herbal medicine. Methods: This cohort study was performed on 298 DKD patients from June 2020 to June 2024. The patients were divided into risk groups based on Kidney Disease: Improving Global Outcomes (KDIGO) 2024 guidelines. Cox proportional hazards regression models were employed to identify the risk factors that contribute to renal and cardiovascular events. Propensity score matching (PSM) was used as the statistical method to compare 36 treatment-group patients, who were treated with Shenyuan Granules along with standard treatment, with 36 control-group patients, who received standard treatment alone. Furthermore, clinical biochemical indicators, traditional Chinese medicine (TCM) syndrome scores, and cardiovascular and renal endpoints of the two groups were assessed and compared. Results: This study helped identify the risk factors associated with renal and cardiovascular endpoint events in 298 DKD patients. The independent risk factors identified to be associated with renal endpoint events in DKD patients ( P < 0.05) were as follows: advanced age, elevated serum creatinine (Scr), elevated uric acid, elevated platelet lymphocyte ratio (PLR), abdominal aortic calcification (AAC), cardiac valve calcification (CVC), increased left ventricular mass index (LVMI), and left ventricular hypertrophy (LVH). However, the independent risk factors identified to be associated with cardiovascular endpoint events in DKD patients ( P < 0.05) were as follows: hypertension, AAC, CVC, increased LVMI, LVH, and left ventricle ejection fraction (LVEF) < 55.0%. According to the findings, Shenyuan Granules significantly improved TCM syndrome scores (83.3% and 44.4%, for treatment and control groups, respectively, with P < 0.05 each) in terms of key clinical indicators, including hemoglobin, estimated glomerular filtration rate (eGFR), Scr, 24-hour urinary protein, LVEF, and LVMI. Conclusion: Factors such as AAC, CVC, LVH, and increased LVMI can continue to deteriorate kidneys and increase the risk of cardiovascular diseases. However, Shenyuan Granules offer promising results in significantly improving renal and cardiac function and alleviating the clinical symptoms of DKD patients.

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