Objective  To investigate the efficacy, safety and influencing factors of the dapagliflozin and empagliflozin in the treatment of patients with diabetic nephropathy (DN) in the real world.

Methods  The data of patients with DN who received dapagliflozin or empagliflozin treatment at Nanjing Drum Tower Hospital from January 2020 to December 2024 were collected. Inverse probability of treatment weighting (IPTW) was used to balance the two groups of covariates, and the glycated hemoglobin (HbA1c), fasting blood glucose (FPG), postprandial blood glucose (2hPG), urine microalbumin (mAlb), urine microalbumin/creatinine ratio (UACR), estimated glomerular filtration rate (eGFR) and uric acid (UA) level were compared between the two groups before and after 6 months of treatment, and the progress of the disease and the occurrence of adverse reactions were recorded in follow-up. The Kaplan-Meier method and Log-rank test were used to analyze disease progression, and the Logistic regression model was used to analyze the influencing factors of adverse reactions in each group.

Results  A total of 305 patients were included, there was no statistically significant difference in baseline between the two groups after IPTW. After treatment, the levels of HbA1c, FPG, 2hPG, mAlb and UACR of the two groups decreased significantly (P<0.05). And the 2hPG, eGFR and UA levels were better in the dapagliflozin group than in the empagliflozin group (P<0.05). There was no significant difference in the adverse reaction rate of the two groups (P>0.05). The median progression-free survival time of dapagliflozin group was 47 months, which was significantly higher than that of 35 months of empagliflozin treatment (P<0.05). Multivariate analysis results showed that diabetes course over 10 years, hyperuricemia, and vitamin D deficiency are risk factors for adverse reactions in the dapagliflozin group, and the combination of uric acid-lowering drugs was the risk factor for adverse reactions in the empagliflozin group.

Conclusion  Compared with empagliflozin, dapagliflozin demonstrates greater advantages in delaying the progression of DN, it can significantly reduce 2hPG and UA levels, and the safety of dapagliflozin is equivalent to empagliflozin.

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