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Sodium-glucose cotransporter 2 inhibitor-induced reduction in the mean arterial pressure improved renal composite outcomes in type 2 diabetes mellitus patients with chronic kidney disease: A propensity score-matched model analysis in Japan.
Kobayashi, Kazuo; Toyoda, Masao; Hatori, Nobuo; Furuki, Takayuki; Sakai, Hiroyuki; Sato, Kazuyoshi; Miyakawa, Masaaki; Tamura, Kouichi; Kanamori, Akira.
Afiliação
  • Kobayashi K; Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
  • Toyoda M; Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
  • Hatori N; Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
  • Furuki T; Department of internal medicine, Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, lsehara, Japan.
  • Sakai H; Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
  • Sato K; Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
  • Miyakawa M; Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
  • Tamura K; Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
  • Kanamori A; Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
J Diabetes Investig ; 12(8): 1408-1416, 2021 Aug.
Article em En | MEDLINE | ID: mdl-33377605
AIMS/INTRODUCTION: Large-scale clinical trials have reported that, in patients with type 2 diabetes mellitus, sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment affords favorable renal outcomes; the underlying mechanisms, however, remain unclear. Thus, this study investigated how SGLT2 inhibitor-induced changes in the mean arterial pressure (MAP; denoted as ΔMAP) are associated with renal outcomes in type 2 diabetes mellitus patients with chronic kidney disease (CKD). MATERIALS AND METHODS: We retrospectively assessed the data of 624 Japanese type 2 diabetes mellitus patients with CKD who had been using SGLT2 inhibitors for >1 year. For propensity score matching (1:1 nearest neighbor match, with caliper value = 0.053, no replacement), patients were categorized into two groups based on the ΔMAP (>-4 mmHg [n = 329] and ≤-4.0 mmHg [n = 295]). Composite albuminuria progression or a ≥15% annual reduction in the estimated glomerular filtration rate was regarded as the end-point. RESULTS: Per group, 173 propensity-matched patients were compared. Patients with ΔMAP ≤-4 mmHg had a significantly lower incidence of composite renal outcomes than those with ΔMAP ≥-4 mmHg (5.8% [n = 10] vs 15.6% [n = 27], P = 0.003). Although the between-group differences in the estimated glomerular filtration rates were non-significant, patients with a ΔMAP ≤-4 mmHg had significantly larger reductions in the logarithmic urine albumin-to-creatinine ratio (P = 0.005). CONCLUSIONS: The degree of blood pressure reduction after SGLT2 inhibitor treatment influenced renal composite outcomes in Japanese type 2 diabetes mellitus patients with CKD, confirming the importance of blood pressure management in type 2 diabetes mellitus patients with CKD, even when they are under SGLT2 inhibitor treatment.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Mellitus Tipo 2 / Insuficiência Renal Crônica / Pressão Arterial / Inibidores do Transportador 2 de Sódio-Glicose / Hipoglicemiantes Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Asia Idioma: En Revista: J Diabetes Investig Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Japão País de publicação: Japão

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Diabetes Mellitus Tipo 2 / Insuficiência Renal Crônica / Pressão Arterial / Inibidores do Transportador 2 de Sódio-Glicose / Hipoglicemiantes Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Limite: Aged / Female / Humans / Male / Middle aged País/Região como assunto: Asia Idioma: En Revista: J Diabetes Investig Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Japão País de publicação: Japão