Background and Aim: Direct comparison between sodium glucose cotransporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP1Ra) —that have shown a renal protective effect in previous large-scale clinical trials—has not been evaluated thoroughly. The aim of this study is to clarify the difference between the renal protective effect of SGLT2i and GLP1Ra treatment, depending on the decreased mean arterial pressure (MAP) .

Methods: We conducted different retrospective surveys for patients treated with SGLT2i and GLP1Ra, continuously administered over a period of more than 1 year. This study included 541 SGLT2i-treated patients without the concomitant use of GLP1Ra and 265 GLP1Ra-treated patients without the concomitant use of SGLT2i. We constructed two cohort models based on the change in MAP after treatment (ΔMAP) . The comparisons between SGLT2i and GLP1Ra were performed with a generalized linear model, including inverse probability weights using the propensity score.

Results: In the ΔMAP<0 model, SGLT2i-treated patients (n=316) showed a significant increase in eGFR and a decrease in the logarithmic value of the urine albumin-to-creatinine ratio, when compared with GLP1Ra-treated patients (n=142) (the differences were 2.7 mL/min/1.73m2 per year [5% confidence interval (CI) : 0.1, 5.2], p = 0.04, and -0.14 [95% CI: -0.26, -0.03], p = 0.01, respectively) . In addition, a significantly larger decrease in the MAP of SGLT2i-treated patients was observed (-2.3 mmHg [95% CI, -4.4, -0.3], p = 0.02) , when compared with that of GLP1Ra-treated patients. In the ΔMAP≥0 model, no significant difference was observed between the two groups.

Conclusion: The decrease in blood pressure was related to the more favorable influence on renal function in SGLT2i-treated patients than in GLP1Ra-treated patients.


K.Kobayashi: None. M.Toyoda: None. N.Hatori: None. K.Tamura: None.

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