Factors affecting the sodium-glucose cotransporter 2 inhibitors-related initial decline in glomerular filtration rate and its possible effect on kidney outcome in chronic kidney disease with type 2 diabetes: The Japan Chronic Kidney Disease Database.
Diabetes Obes Metab
; 26(7): 2905-2914, 2024 Jul.
Article
de En
| MEDLINE
| ID: mdl-38719436
ABSTRACT
AIM:
Sodium-glucose cotransporter 2 (SGLT2) inhibitors often cause a transient decrease in glomerular filtration rate (GFR) shortly after the initiation, referred to as the 'initial drop'. However, the clinical significance of this initial drop in real-world practice remains unclear. MATERIALS ANDMETHODS:
Using the nationwide Japan Chronic Kidney Disease Database, we examined factors that affected the initial drop, in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). We also evaluated the effects of the initial drop on a composite kidney outcome (a decline in GFR of ≥50% or progression to end-stage kidney disease).RESULTS:
Data from 2053 patients with CKD and T2DM newly prescribed an SGLT2 inhibitor were analysed. The follow-up period after SGLT2 inhibitor administration was 1015 days (interquartile range 532, 1678). Multivariate linear regression models revealed that the concomitant use of the renin-angiotensin system inhibitors and diuretics, urinary protein levels ≥2+, and changes in GFR before the initiation of the SGLT2 inhibitor were associated with a larger initial GFR decline (ß = -0.609, p = .039; ß = -2.298, p < .001; ß = -0.936, p = .048; ß = -0.079, p < .001, respectively). Patients in the quartile with the largest initial GFR decline experienced a higher incidence of the subsequent composite kidney outcome than those in the other quartiles (p < .001).CONCLUSIONS:
The concomitant use of renin-angiotensin system inhibitors and diuretics, higher urine protein levels and pre-treatment GFR changes were associated with a larger initial GFR decline. Of these factors, the use of a diuretic had the largest effect. Furthermore, patients with CKD and T2DM experiencing an excessive initial GFR drop might be at a higher risk of adverse kidney outcomes.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Bases de données factuelles
/
Évolution de la maladie
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Diabète de type 2
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Néphropathies diabétiques
/
Insuffisance rénale chronique
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Inhibiteurs du cotransporteur sodium-glucose de type 2
/
Débit de filtration glomérulaire
Limites:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Pays/Région comme sujet:
Asia
Langue:
En
Journal:
Diabetes Obes Metab
Sujet du journal:
ENDOCRINOLOGIA
/
METABOLISMO
Année:
2024
Type de document:
Article
Pays d'affiliation:
Japon