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...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-11-01
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| Series: | Journal of Diabetes Investigation |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jdi.13064 |
| _version_ | 1818566640230465536 |
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| author | Hideaki Miyoshi Hiraku Kameda Kumiko Yamashita Akinobu Nakamura Yoshio Kurihara |
| author_facet | Hideaki Miyoshi Hiraku Kameda Kumiko Yamashita Akinobu Nakamura Yoshio Kurihara |
| author_sort | Hideaki Miyoshi |
| collection | DOAJ |
| description | 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 (%ΔeGFR−2y) before initiating SGLT2i. The primary end‐point was the change in eGFR 2 years after initiation (%ΔeGFR+2y) compared with %ΔeGFR−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. %ΔeGFR+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 %ΔeGFR+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. |
| first_indexed | 2024-12-14T01:56:20Z |
| format | Article |
| id | doaj.art-8d7b756f6b7e40d3930a4bdaec908fb7 |
| institution | Directory Open Access Journal |
| issn | 2040-1116 2040-1124 |
| language | English |
| last_indexed | 2024-12-14T01:56:20Z |
| publishDate | 2019-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Diabetes Investigation |
| spelling | doaj.art-8d7b756f6b7e40d3930a4bdaec908fb72022-12-21T23:21:11ZengWileyJournal of Diabetes Investigation2040-11162040-11242019-11-011061510151710.1111/jdi.13064Protective effect of sodium–glucose cotransporter 2 inhibitors in patients with rapid renal function decline, stage G3 or G4 chronic kidney disease and type 2 diabetesHideaki Miyoshi0Hiraku Kameda1Kumiko Yamashita2Akinobu Nakamura3Yoshio Kurihara4Division of Diabetes and Obesity Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo JapanDepartment of Rheumatology, Endocrinology and Nephrology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo JapanKurihara Clinic Sapporo JapanDepartment of Rheumatology, Endocrinology and Nephrology Faculty of Medicine and Graduate School of Medicine Hokkaido University Sapporo JapanKurihara Clinic Sapporo JapanAbstract 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 (%ΔeGFR−2y) before initiating SGLT2i. The primary end‐point was the change in eGFR 2 years after initiation (%ΔeGFR+2y) compared with %ΔeGFR−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. %ΔeGFR+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 %ΔeGFR+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.https://doi.org/10.1111/jdi.13064Estimated glomerular filtration rateKidney diseaseSodium–glucose cotransporter 2 inhibitors inhibitor |
| spellingShingle | Hideaki Miyoshi Hiraku Kameda Kumiko Yamashita Akinobu Nakamura Yoshio Kurihara 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 Journal of Diabetes Investigation Estimated glomerular filtration rate Kidney disease Sodium–glucose cotransporter 2 inhibitors inhibitor |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Estimated glomerular filtration rate Kidney disease Sodium–glucose cotransporter 2 inhibitors inhibitor |
| url | https://doi.org/10.1111/jdi.13064 |
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