Clinical Efficacy of Levocarnitine-Alprostadil Combination Therapy on Indicators of Renal Function, Oxidant-Antioxidant Balance, and Systemic Inflammation in Patients with End-Stage Diabetic Nephropathy

Objective: To investigate the effects of combined Levocarnitine and Alprostadil therapy on renal function, oxidant-antioxidant balance, and systemic inflammation in patients with end-stage diabetic nephropathy (ESDN). Methods: This retrospective study included 104 ESDN patients admitted to our hospital between April 2021 and April 2023 who met all inclusion criteria. All patients were on maintenance hemodialysis for chronic kidney failure due to ESDN. Based on the treatment regimen received, patients were divided into two groups: the control (n=51) received intravenous Alprostadil (20 μg/day) for 30 days in addition to standard care, and the observation group (n=53) received additional intravenous Levocarnitine (1.0 g/day) for 30 days. Clinical efficacy, renal function parameters [blood urea nitrogen (BUN), cystatin C (Cys-C), 24-hour urinary protein (24 h Upro)], oxidative stress markers [malondialdehyde (MDA), superoxide dismutase (SOD), reactive oxygen species (ROS)], inflammatory factors [C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin-6 (IL-6)], and adverse reactions were compared between groups. Results: The cumulative treatment effectiveness (defined as the sum of patients with "markedly effective" and "effective" outcomes) was significantly higher in the observation group (92.45%) compared to the control group (78.43%, P<0.05). Post-treatment, the observation group demonstrated significantly greater improvements in all parameters: lower BUN (4.35±1.06 vs 5.29±1.12 mmol/L), Cys-C (1.21±0.34 vs 1.75±0.46 mg/L), 24 h Upro (66.79±18.37 vs 75.17±19.54 mg/24h), MDA (3.54±0.89 vs 4.63±1.08 nmol/mL), ROS (371.34±46.32 vs 417.53±48.16 U/mL), CRP (5.02±0.83 vs 6.63±0.94 mg/L), IL-1β (11.04±2.38 vs 13.61±2.67 pg/mL), and IL-6 (12.78±3.51 vs 16.84±4.53 pg/mL), alongside higher SOD (88.17±9.34 vs 72.49±8.71 U/mL) (P<0.05). Adverse reaction incidence showed no significant difference (16.98% vs 13.73%, P>0.05). Conclusion: In ESDN patients, the combination of Levocarnitine and Alprostadil demonstrates superior cumulative treatment effectiveness over Alprostadil monotherapy in improving renal function, reducing oxidative stress, and attenuating inflammation, without increasing the incidence of adverse reactions.