Protective effect of sodium-glucose cotransporter 2 inhibitors in patients with rapid renal function decline, stage G3 or G4 chronic kidney disease and type 2 diabetes.

ABSTRACT: AIMS/INTRODUCTION:The risk of end-stage kidney disease increases in proportion to the decline in the estimated glomerular filtration rate (eGFR). Although protective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on the eGFR decline were shown in several large-scale clinical trials, there are no studies investigating patients with a high risk of end-stage kidney disease. We investigated the efficacy and safety of SGLT2i in advanced renal dysfunction patients (stage G3 or G4 of chronic kidney disease) with a rapid decline in eGFR. MATERIALS AND METHODS:This retrospective, longitudinal study enrolled patients with type 2 diabetes who were treated with SGLT2i, and whose eGFR was <60 mL/min/1.73 m2 and had declined >20% over 2 years (%?eGFR-2y) before initiating SGLT2i. The primary end-point was the change in eGFR 2 years after initiation (%?eGFR+2y) compared with %?eGFR-2y. RESULTS:A total of 17 patients among 553 patients treated with SGLT2i for ?2 years were included in the study. The average age, glycated hemoglobin and eGFR at SGLT2i initiation were 68.5 years, 7.3% and 38.3 mL/min/1.73 m2 , respectively. %?eGFR+2y in patients who were treated with SGLT2i was significantly increased compared with the patients not treated with SGLT2i (2.3 and -21.7%, respectively; P < 0.0001). A multiple regression analysis showed that only the proportion of the rate of eGFR decline was the independent factor associated with improvement of %?eGFR+2y. There was no increase in serious adverse events including acute kidney injury. CONCLUSIONS:SGLT2i was safe, and prevented further eGFR decline in patients with type 2 diabetes and advanced renal dysfunction.

SUBMITTER: Miyoshi H 

PROVIDER: S-EPMC6825940 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature