Larger degree of renal function decline in CKD is a favorable factor for the attenuation of eGFR slope worsening by SGLT2 inhibitors: a retrospective observational study.

INTRODUCTION: Sodium-glucose cotransporter 2 inhibitors (SGLT2Is) have beneficial effects on the renal function of chronic kidney disease (CKD) patients, although the types of patients suitable for this treatment remain unclear. METHODS: A retrospective observational study was conducted on CKD patients who were treated with SGLT2I at our department from 2020 to 2023. The estimated glomerular filtration rate (eGFR) just before treatment was defined as the baseline and the difference between pre-and post-treatment eGFR slopes were used to compare the improvement of renal function. Logistic regression analysis was used to evaluate the independent factors for its improvement. RESULTS: A total of 128 patients were analyzed (mean age: 67.2 years; number of women: 28 [22%]). The mean eGFR was 42.1 ml/min/1.73 m2, and urine protein was 0.66 g/gCr. The eGFR slopes of patients with an eGFR < 30 ml/min/1.73 m2 were improved significantly after treatment (-0.28 to -0.14 ml/min/1.73 m2/month, P < 0.001) but were worsened in patients with an eGFR ≥ 30 ml/min/1.73 m2. Logistic analysis for the improvement in eGFR slopes showed that women (odds ratio [OR], 5.63; 95% confidence interval [CI], 1.16 to 27.3; P = 0.03), use of mineral corticoid receptor antagonists (OR, 11.79; 95% CI, 1.05 to 132.67; P = 0.012) and rapid decline of eGFR before treatment (OR, 12.8 per ml/min/1.73 m2/month decrease in eGFR; 95% CI, 3.32 to 49.40; P < 0.001) were significant independent variables. CONCLUSION: SGLT2Is may have beneficial effects especially for rapid decliners of eGFR, including advanced CKD.

Structural changes in renal arterioles are closely associated with central hemodynamic parameters in patients with renal disease.

Although central hemodynamics are known to be closely associated with microvascular damage, their association with lesions in the small renal arteries has not yet been fully clarified. We focused on arterioles in renal biopsy specimens and analyzed whether their structural changes were associated with noninvasive vascular function parameters, including central blood pressure (BP) and brachial-ankle pulse wave velocity (baPWV). Forty-four nondiabetic patients (18-50 years of age) with preserved renal function underwent renal biopsy. Wall thickening of arterioles was analyzed based on the media/diameter ratio, and hyalinosis was analyzed by semiquantitative grading. Associations of these indexes (arteriolar wall remodeling grade index (RG index) and arteriolar hyalinosis index (Hyl index)) with clinical variables were analyzed. Multiple regression analyses demonstrated that the RG index was significantly associated with central systolic BP (ß = 0.97, p = 0.009), serum cystatin C-based estimated glomerular filtration rate (ß = -0.36, p = 0.04), and high-density lipoprotein cholesterol levels (ß = -0.37, p = 0.02). The Hyl index was significantly associated with baPWV (ß = 0.75, p = 0.01). Our results indicate that aortic stiffness and abnormal central hemodynamics are closely associated with renal microvascular damage in young to middle-aged, nondiabetic kidney disease patients with preserved renal function.