Objective: Prevention of end stage kidney disease is one of the priorities in diabetes management. But very few data are available in using sodium glucose transporter 2 inhibitor (SGLT2i) at advanced chronic kidney disease (CKD). We assessed annual eGFR decline rate (slope) in patients with type 2 diabetes with diabetic kidney disease (DKD) treated by SGLT2i.

Methods: A total of 75 patients with DKD, treated by SGLT2i (on empagliflozin 64% and others), were analyzed. Average age was 70.7±12.2 year-old and duration of diabetes was 15.0±9.3 years. Initial eGFR slopes were calculated from 46±21 months period, and slopes after adding SGLT2i were calculated from 21±8 months. Efficacy was compared by each CKD stage: stage 3A; eGFR 45-59 (n=29), stage 3B; eGFR 30-44 (n=28) and stage 4; eGFR<30ml/min/1.73m2 (n=18) at the time of recruitment (middle in 2019).

Results: 1) Average of initial (first month) eGFR changes (drops) are as follows; stage 3A; 57.8±10.5 to 54.9±10.3 ml/min/1.73m2 (P<0.05), stage 3B; 43.2±7.1 to 40.9±6.5 ml/min/1.73m2 (P<0.01), stage 4; 30.6±10.2 to 28.7±9.4ml/min/1.73m2 (P<0.01). The start of SGLT2i treatment decreased eGFR 1.9-2.9ml/min/1.73m2 on initial month. However, annual mean eGFR slopes were improved in all stages; stage 3A: -4.2±3.7 to -1.8±4.4ml/min/1.73m2/year (P<0.02), stage 3B; -4.8±3.7 to -1.7±2.7ml/min/1.73m2/year (P<0.001), stage 4; -12.3±16.3 to -1.9±4.6ml/min/1.73m2/year (P=0.01). 2) The proportion of showing reduction of eGFR slopes after the start of SGLT2i (responder) are similar in all stages: stage 3A; 66% (19/29), stage 3B; 75% (21/28), stage 4; 78%; (14/18). Changes of mean eGFR slopes in those responders were as follows, -8.1±10.3 to -0.6±3.3ml/min/1.73m2/year (P<0.0001).

Conclusion: SGLT2i treatment could have a favorable benefit on renal function even in advanced stage of DKD. Slope analysis might be useful for safety and individualized therapy.


K. Kashima: None. H. Shimizu: None. M. Yamada: None.

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