Effect of Empagliflozin on Urinary Excretion of Adenosine and Osteocyte Function in Patients With Chronic Kidney Disease

The study will be prospective, interventional and will be conducted in two parallel groups selected on the basis of clinical diagnosis. It is planned to enroll 60 patients aged 18-70 years under outpatient nephrological care, with impaired excretory function of the kidneys (eGFR 20-60 ml / min / 1.73 m3), with proteinuria above 0.5-3 g / l in the morning urine sample , including 30 nondiabetic and 30 diabetic patients t.2 and 20 healthy control subjects (no microalbuminuria and no impaired renal function with eGFR\> 90 ml / min / 1.73m3). After the patients are familiarized with the objectives of the study and the informed consent signed, the following procedures will be performed. After signing the consent, basic biochemical tests will be performed in both groups to assess the concentration of protein, albumin, calcium, phosphate, adenosine and creatinine in the morning urine sample, creatinine, calcium, phosphate, PTH, bacterial alkaline phosphatase (BAP), 1.25 vitamin D, sclerostins, FGF23, serum Klotho proteins, eGFR, plasma glucose. The tests will be repeated after 7 days of taking empagliflozin in a dose of 10 mg a day. On days 1 and 7, patients will be given an intravenous glucose 5% solution at a dose of 240 mg glucose / kg body weight in the first 15 minutes to induce a controlled hyperglycaemia state in the first 15 minutes, this will increase their blood glucose by 125 mg / dL in 15 minutes followed by 10-12 mg glucose / kg body weight, under glycemic control to maintain a concentration of 200 mg / dL ± 5% for 120 minutes. Stability of serum glucose levels during this period will be maintained by adjusting the rate of intravenous glucose infusion based on blood glucose measurements, every 15 minutes. After 2 hours of infusion, additional blood will be drawn for the determination of glucose and renal parameters and after 100 ml of urine for determination. adenosine, albumin and creatinine concentrations. In healthy subjects from the control group, the above basic blood and urine biochemical tests will be performed once.