Objective: In type 2 diabetes(T2D), prevalence of chronic kidney disease (CKD) with normoalbuminuria is increasing. We assessed the annual eGFR decline rate (slope) in Japanese patients with T2D with CKD treated by sodium glucose transporter 2 inhibitor (SGLT2i).
Methods: A total of 75 patients with T2D with CKD (eGFR<60ml/min/1.73m2) were recruited, whose initial eGFR slopes were calculated from 46±21 months period, and slopes after adding SGLT2 inhibitors (on empagliflozin 64% and others) were calculated from 21±8 months. Efficacy was compared between in patients with normo-/micro-alubuminuria (Norm/Micro) and with macroalbuminuria (Macro). Patients with Norm/Micro existed in 52% (39/75). At the time of recruitment, distribution in CKD stages are as follows, on stage 3A; eGFR 45-59 (21 vs. 8), stage 3B; eGFR 30-44, (13 vs. 15) and stage 4; eGFR<30 (5 vs. 13) respectively. Average age was 70.7±12.2 years old and duration of diabetes was 15.0±9.3 years.
Results: 1) Average initial (first month) eGFR drop values are as follows, in Norm/Micro (51.2 to 47.9ml/min/1.73m2: P<0.01), in Macro (40.7 to 39.0ml/min/1.73m2: P=0.01). 2) Annual mean eGFR slopes were improved in each group, in Norm/Micro (-4.3±4.0 to -1.2±4.1ml/min/1.73m2/year; P<0.001), and in Macro (-8.9±12.2 to -2.3±3.6ml/min/1.73m2/year; P<0.01). 3) Proportion of showing reduction of eGFR slopes after adding SGLT2i are 69.2% (27/39) and 75.0% (27/36), respectively. And even in stage 4, 80.0% (4/5) and 76.9% (10/13), respectively. 4) Rapid decliner of eGFR (>10 ml/min/1.73m2/year) existed in 12.8% (5/39) and in 25.0% (9/36) respectively. Mean eGFR slopes in these rapid decliner were all improved and as follow, -12.2±2.1 to +1.2±3.4ml/min/1.73m2/year; P<0.001 and -22.3±19.0 to -1.6±4.0ml/min/1.73m2/year; P<0.01, respectively.
Conclusion: SGLT2i could still have a remarkable renal benefit in Norm/Micro diabetic kidney disease. Slope analysis might be useful for safety and detecting rapid eGFR decliner.
K. Kashima: None. H. Shimizu: None. M. Yamada: None.