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.

Disclosure

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

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license.