Renal Damage after Myocardial Infarction is Prevented by Linagliptin, a Dipeptidyl Peptidase Inhibitor, for Cardio-renal Protection

with heart failure (HF). Forty-six ambulatory patients with HF were enrolled in this study. We analyzed the associations between cardiovascular events during 6 months follow-up and baseline clinical characteristics. We divided study patients into two groups; patients with loop diuretics therapy (n527) and those without (n519). Event-free rate of patients with loop diuretics was significantly lower than those without (70.4% vs. 94.7%, p ! 0.05). Multivariate regression analysis revealed that creatine clearance (CCr) was independently associated with poor prognosis. (HR: 0.895, 95%CI: 0.818-0.980, p 5 0.017). In patients with loop diuretics, cortical collecting duct flow rate (CCDFR) was significantly increased (1.7 6 0.5% vs. 2.0 6 0.5%, p!0.05) and the free water retention had a stronger correlation with plasma AVP level (r 5 0.402, p ! 0.05 vs. NS) compared with those in patients without loop diuretics. We also revealed that CCDFR was the significant associated factor with adverse events. (HR: 5.366, 95%CI: 1.090-26.418, p 5 0.039). In conclusion, renal dysfunction is a strong associated factor with poor prognosis. Loop diuretics increase CCDFR and develop the sensitivity to AVP. Those renal functional changes induced may play an important role in diuretic resistance.