Aim: Study the effect of Sacubitril/valsartan (SV) combination therapy on renal functions in T2DM receiving canagliflozin (C).
Methodology: Between July and Sept 2018, T2DM patients aged 18-75 yrs, irrespective of baseline A1c, receiving SVC or C were retrospectively identified. The use of angiotensin receptor blockers (ARB) was 28.6% in SVC gr and 57% in C gr. Propensity score 1:1 matching was done for gr receiving SVC (49 patients) with C (49 patients) for variables to minimise confounding. Patients were evaluated 3 mthly for cardio-renal biomarkers (BMI, A1c, SBP, DBP, Lipid profile (TC, LDL, TG, HDL), Hs-CRP, Nt-ProBNP, creatinine (Cr), eGFR and microalbumin/creatinine ratio {UACR}) for 1 yr. T2DM with H/O IHD, revasularisation, major surgery, K+>5.5Meq/L and eGFR<45 were excluded. Baseline characteristics were analysed using descriptive statistics. Continuous variables were analysed using paired and unpaired t-test expressed as mean ± standard error. For interaction between drug class, ANOVA was used and p value <0.05 was considered significant (S).
Results: Baseline (B) characters: well matched except for age-yrs (SVC 61.27+9.43 and C 56+9.68, p-0.024) and NT-proBNP-pg/ml (SVC 438.68+758.13 vs. C 58.43+53.475, p-0.001). SVC, B-12mnths - S change in SBP, Hba1c, TC, LDL, TG, UACR and hs-CRP. C, B-12mnths - S change in BMI, SBP, DBP, HbA1c, TC, LDL, TG. SVC Versus C at 12mnths - No S difference seen for BMI-kg/m2 (SVC 0.381+0.297 vs. C 0.934+0.215, P-0.136), S-BP-mm (SVC 8.51+2.62 vs. C 6.429+2.349, p-0.556), D-BP-mm (SVC 2.143+1.582 vs. C 2.959+1.457, p-0.705), A1c-% (SVC 0.644+0.143 vs. C 0.677+0.190, p-0.88), Cr-mg% (SVC -0.009+0.025 vs. C 0.0067+0.0225, p-0.638), eGFR (SVC 1.307+2.388 vs. C 1.554+3.177, p-0.953), UACR mg/gm (SVC 52.876+22.684 vs. C 49.517+39.943, p-0.920), hs-CRP mg/L and Lipid Profile. There was no interaction with use of ARB for eGFR (p-0.074) and UACR (p-0.056).
Conclusion: SV does not provide additional renal benefits in T2DM receiving C.
V. Gupta: None. V. Teli: None.
