The impact of dynamic kidney function prior to using sodium-glucose cotransporter-2 inhibitors in type 2 diabetes patients with low-risk renal disease progression

Abstract

Aims/introduction: Few studies have assessed whether dynamic kidney function prior to sodium-glucose cotransporter-2 inhibitor (SGLT2i) initiation influenced subsequent renal outcomes. Thus, the study aimed to investigate whether combining estimated glomerular filtration rate (eGFR) slope and urinary albumin/creatinine ratio (UACR) change prior to using SGLT2i contributes to subsequent kidney outcomes.

Materials and methods: This retrospective cohort study utilized data from the Kaohsiung Medical University Hospital Research Database (KMUHRD) in Taiwan. We identified 975 SGLT2i new users with type 2 diabetes from 2016 to 2020, who had an eGFR >60 mL/min/1.73 m² and UACR <30 mg/g 1 year prior to using SGLT2i. Patients were categorized into four groups based on an eGFR decline rate of 2.5 mL/min/1.73 m²/year and a UACR increase of 30%. The primary study outcomes included a >30% eGFR decline with a drop in eGFR categories and a >43% UACR increase with progression in UACR categories.

Results: After SGLT2i treatment, compared with the non-progressive renal function group, the glomerular injury group significantly lowered the risk of eGFR decline (adjusted hazard ratio [95% CI] 0.384 [0.199, 0.740]) and UACR progression (adjusted hazard ratio [95% CI] 0.514 [0.313, 0.846]). In addition, for those with a major eGFR decline before starting SGLT2i, significant improvements in the eGFR slope (P < 0.05) were observed after the treatment, irrespective of UACR increase.

Conclusions: Early initiation of SGLT2i among type 2 diabetes patients with low-risk renal disease progression and glomerular injury renal status may prevent them from progressing into chronic kidney disease.

Keywords: Annual estimated glomerular filtration rate decline; Sodium–glucose cotransporter 2 inhibitor; Urine albumin‐to‐creatinine ratio.