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
Abstract 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 SGL...
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| Format: | Article |
| Language: | English |
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Wiley
2021-08-01
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| Series: | Journal of Diabetes Investigation |
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| Online Access: | https://doi.org/10.1111/jdi.13491 |
| _version_ | 1818620185062408192 |
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| author | Kazuo Kobayashi Masao Toyoda Nobuo Hatori Takayuki Furuki Hiroyuki Sakai Kazuyoshi Sato Masaaki Miyakawa Kouichi Tamura Akira Kanamori |
| author_facet | Kazuo Kobayashi Masao Toyoda Nobuo Hatori Takayuki Furuki Hiroyuki Sakai Kazuyoshi Sato Masaaki Miyakawa Kouichi Tamura Akira Kanamori |
| author_sort | Kazuo Kobayashi |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-16T17:49:21Z |
| format | Article |
| id | doaj.art-336ae2edd3f9447380440ee6088616c4 |
| institution | Directory Open Access Journal |
| issn | 2040-1116 2040-1124 |
| language | English |
| last_indexed | 2024-12-16T17:49:21Z |
| publishDate | 2021-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Investigation |
| spelling | doaj.art-336ae2edd3f9447380440ee6088616c42022-12-21T22:22:22ZengWileyJournal of Diabetes Investigation2040-11162040-11242021-08-011281408141610.1111/jdi.13491Sodium–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 JapanKazuo Kobayashi0Masao Toyoda1Nobuo Hatori2Takayuki Furuki3Hiroyuki Sakai4Kazuyoshi Sato5Masaaki Miyakawa6Kouichi Tamura7Akira Kanamori8Committee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanCommittee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanCommittee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanCommittee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanCommittee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanCommittee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanCommittee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanDepartment of Medical Science and Cardiorenal Medicine Yokohama City University Graduate School of Medicine Yokohama JapanCommittee of Hypertension and Kidney disease Kanagawa Physicians Association Yokohama JapanAbstract 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.https://doi.org/10.1111/jdi.13491Blood pressureChronic kidney diseaseSodium–glucose cotransporter 2 inhibitors |
| spellingShingle | Kazuo Kobayashi Masao Toyoda Nobuo Hatori Takayuki Furuki Hiroyuki Sakai Kazuyoshi Sato Masaaki Miyakawa Kouichi Tamura Akira Kanamori 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 Journal of Diabetes Investigation Blood pressure Chronic kidney disease Sodium–glucose cotransporter 2 inhibitors |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Blood pressure Chronic kidney disease Sodium–glucose cotransporter 2 inhibitors |
| url | https://doi.org/10.1111/jdi.13491 |
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