Impact of sodium–glucose cotransporter 2 inhibitors on renal function in participants with type 2 diabetes and chronic kidney disease with normoalbuminuria

Abstract

Background: We compared the effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors on renal function in participants with type 2 diabetes and chronic kidney disease (CKD) classified by degree of albuminuria. Methods:A retrospective review of the clinical records of Japanese participants with type 2 diabetes (age > 20 years; SGLT2 inhibitor treatment > 2 years; estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m 2 ) was conducted. Based on the urinary albumin-to-creatinine ratio (UACR) or urinary protein-to-creatinine ratio (UPCR) at the start of SGLT2 inhibitor administration, participants were categorized into three groups: normoalbuminuria (A1; UACR < 30 mg/g Cr or UPCR < 0.15 g/g Cr), microalbuminuria (A2; UACR 30 to < 300 mg/g Cr or UPCR 0.15 to < 0.50 g/g Cr), and macroalbuminuria (A3; UACR ≥ 300 mg/g Cr or UPCR ≥ 0.50 g/g Cr). The study outcome was a comparison of the rates of change in renal function evaluated by eGFR at 2 years after starting SGLT2 inhibitor among the three groups.Results: A total of 87 participants (40 females, 47 males) were categorized into three groups: A1 (n = 46), A2 (n = 25), and A3 (n = 16). eGFR was similarly decreased at 2 years before starting SGLT2 inhibitor in all three groups. However, the decline in eGFR was ameliorated at 2 years after starting SGLT2 inhibitor, and eGFR was rather increased in the A1 and A2 groups. Interestingly, the rate of change in eGFR at 2 years after starting SGLT2 inhibitor in the A1 group was significantly higher than that in the A3 group. Conclusions:These results demonstrate that more favorable effects of SGLT2 inhibitors on renal function were observed in participants with type 2 diabetes and CKD with normoalbuminuria compared with those with macroalbuminuria.

Initial dip predicts renal protective effects after the administration of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and chronic kidney disease with normoalbuminuria

“…In the present study, we showed that additional treatment with SGLT2is prevents the decline in eGFR in the SGLT2 group compared with that in the control group. Although we had previously shown that more favorable effects of SGLT2is on renal function in patients with type 2 diabetes and CKD with normoalbuminuria compared with patients with macroalbuminuria [9], this study did not include a control group. Therefore, this study was able to confirm the renoprotective effects on SGLT2is for patients with type 2 diabetes and CKD with normoalbuminuria compared with non-SGLT2is user.…”

“…Four large prospective clinical trials have shown that SGLT2is decrease the composition renal endpoints such as decline in estimated glomerular filtration rate (eGFR), doubling of the serum creatinine level, new end-stage kidney disease, death from renal or cardiovascular causes, or progression to macroalbuminuria [3][4][5][6]. In addition, it has been reported that, in patients with type 2 diabetes and chronic 6 kidney disease (CKD), SGLT2is prevent the decline in eGFR [7][8][9][10]. However, studies on the effects of SGLT2is on renal function in patients with type 2 diabetes and CKD with normoalbuminuria remain limited [8,9].…”

“…In addition, it has been reported that, in patients with type 2 diabetes and chronic 6 kidney disease (CKD), SGLT2is prevent the decline in eGFR [7][8][9][10]. However, studies on the effects of SGLT2is on renal function in patients with type 2 diabetes and CKD with normoalbuminuria remain limited [8,9].…”

Initial dip predicts renal protective effects after the administration of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and chronic kidney disease with normoalbuminuria

“…Four large prospective clinical trials have shown that SGLT2is decrease the composition renal endpoints such as decline in estimated glomerular filtration rate (eGFR), doubling of the serum creatinine level, new end-stage kidney disease, death from renal or cardiovascular causes, or progression to macroalbuminuria [4] , [5] , [6] , [7] . In addition, it has been reported that, in patients with type 2 diabetes and chronic kidney disease, SGLT2is prevent the decline in eGFR [8] , [9] , [10] , [11] . However, studies on the effects of SGLT2is on renal function in patients with type 2 diabetes and CKD with normoalbuminuria remain limited [9] , [10] .…”

“…In addition, it has been reported that, in patients with type 2 diabetes and chronic kidney disease, SGLT2is prevent the decline in eGFR [8] , [9] , [10] , [11] . However, studies on the effects of SGLT2is on renal function in patients with type 2 diabetes and CKD with normoalbuminuria remain limited [9] , [10] .…”