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.

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.