Abstract: 【Abstract】Objective The aim of the present study was to elucidate the protective effects of calcium dobesilate (CaD) against diabetes-induced endothelial dysfunction and inflammation as well as the safety and efficacy of CaD in the treatment of diabetic kidney disease (DKD). Methods This was a prospective and casecontrol study to observe the differences in endothelial and inflammation related markers among DKD patients, diabetic patients without proteinuria and healthy individuals. DKD patients were then randomly divided into the treatment group (CaD 500mg, 3 times daily) and the observation group. They were treated for 3 months. Endothelial function markers including vascular endothelial growth factor (VEGF), endothelin-1(ET-1), endothelial nitric oxide synthase (eNOS) and nitric oxide (NO) and inflammation markers including monocyte chemotactic protein 1 (MCP-1), intercellular cell adhesion molecule-1 (ICAM) and pentraxin 3 (PTX3) were assayed. Results In the 100 DKD patients, PTX3, MCP-1, ICAM, VEGF and ET-1 were significantly higher than those in diabetic patients without proteinuria (P＜0.001) and were positively correlated with the microamount of albuminuria (r=0.356, 0.254, 0.247, 0.267, 0.216 respectively; P=0.001, 0.003, 0.004, 0.002 and 0.012 respectively). NO was significantly lower in DKD patients than in diabetic patients without proteinuria (P＜0.001) and was negatively correlated with the micro-amount of albuminuria (r=-0.229, P=0.027). Logis-tic regression analysis showed that PTX3 (OR=2.761, 95% CI: 1.358～5.615, P=0.017), NO (OR=0.941, 95% CI: 0.905～0.979, P=0.003) and HbAlc (OR=3.304, 95% CI: 1.228～8.884, P=0.019) were the influence factors
for DKD. ROC curve showed that PTX3, NO and HbAlc levels were the predictive markers for the presence of DKD in diabetic patients. In the prospectively study of DKD patients treated with CaD for 3 months, their 24 hours urinary albumin and 24 hours urinary protein decreased significantly (P=0.010 and 0.014 respectively) but their cystatin C based GFR did not change. In DKD patients after CaD treatment, inflammation markers of PTX3, MCP-1, hsCRP and ICAM and endothelial markers of VEGF, NO and ET-1 ameliorated significantly as compared with those before CaD treatment (P=0.008, 0.009, 0.040, 0.013, 0.003, 0.001 and 0.004 respectively). Conclusion CaD can improve renal function in DKD patients through the improvement of their micro-inflammation status and endothelial function to reduce proteinuria.

Key words: diabetic kidney disease, endothelial dysfunction, inflammation, Calcium dobesilate