Combined control of comorbidity risk factors to halt renal function deterioration in elderly diabetic patients:a case 8-year follow-up report

Lei Huan; Cheng Guo; Zhou Yingsheng

doi:10.3760/j.issn.1673-4777.2026.07.023

Abstract：This article reports the 8-year follow-up and therapeutic observation of one elderly patient with type 2 diabetic nephropathy.The patient was diagnosed with diabetic nephropathy[chronic kidney disease(CKD)stage G3a and A2]at the initial visit,accompanied by hypertension,dyslipidemia,hyperuricemia and obesity.Insulin combined with dipeptidyl peptidase Ⅳ inhibitor was initially administered to control blood glucose,which was later adjusted to canagliflozin,a sodium-glucose cotransporter 2 inhibitor(SGLT2i);the antihypertensive regimen was adjusted to perindopril,an angiotensin-converting enzyme inhibitor(ACEI),combined with sustained-release nifedipine,a calcium channel blocker(CCB);lipid-lowering therapy was adjusted to atorvastatin combined with ezetimibe;allopurinol was used to reduce serum uric acid.In accordance with the recommendations of the Chinese guidelines for the prevention and treatment of type 2 diabetes mellitus,the comprehensive control targets for this patient were glycated hemoglobin(HbA1c)＜7.5％,blood pressure＜130/80 mmHg and low-density lipoprotein cholesterol(LDL-C)＜1.8 mmol/L,so as to halt renal function deterioration.During the continuous 8-year follow-up treatment from 2018 to 2025,the patient's disease indicators were significantly improved:HbA1c decreased from 9.2％to 7.9％,blood pressure dropped from 140/80 mmHg to 131/73 mmHg,LDL-C declined from 2.7 mmol/L to 1.4 mmol/L,serum uric acid returned to normal,and the urinary albumin/creatinine ratio fell from 33.2 mg/g to 14.4 mg/g,with the CKD stage improved from A2 to A1.The estimated glomerular filtration rate(eGFR)remained stable at 37.1-38.8 ml/(min·1.73 m2)in the recent 3 years,reaching 38.0 ml/(min·1.73 m2)in 2025.The eGFR only decreased by 16.7 ml/(min·1.73 m2)over the 8 years,with an average annual decline of merely 2.1 ml/(min·1.73 m2),indicating that renal function deterioration was markedly halted.The comprehensive therapeutic regimen of this patient based on SGLT2i for hypoglycemia,ACEI combined with CCB for hypertension,and statin combined with cholesterol absorption inhibitor for dyslipidemia significantly improved multiple indicators including HbA1c,blood pressure and LDL-C,and retarded the deterioration of renal function caused by diabetic nephropathy.