Background: Both sodium glucose co-transporter 2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP1Ras) showed robust evidences for not only cardiovascular but also renal outcomes and the combination treatment of these drugs is increasing in clinical practice. We previously reported that the preceding drug did not influence the renal outcomes in patients with these combination treatments. We also reported the importance of post blood pressure (BP) management for the renal outcomes in SGLT2i-treated patients, however, it is poorly surveyed in patients with the combination treatment.
Method: A retrospective study was conducted in 418 patients who were treated with both SGLT2i and GLP1Ra. The progression of the albuminuria stage, the eGFR decline of ≥30%, or both were defined as the renal composite outcome. The cut off value of post-treatment mean arterial pressure (post-MAP) were calculated using receiver ROC curve analysis. The patients were divided into two groups by the cut-off value and propensity score (PS) matching method was performed for comparisons between the two groups.
Results: The calculated cutoff value of post-MAP was 87.3 mmHg and the patients were divided into two groups: 281 patients in post-MAP≥87.3 group and 137 patients in post-MAP<87.3 group. Of the 111 PS-matched patients in each group, the renal composite outcome after the combination treatment was observed in 38 patients (34.2%) in post-MAP≥87.3 group, which was significantly higher than in 18 patients (17.1%) in post-MAP<87.3 group (p=0.005). The progression of albuminuria stage was significantly more frequent in post-MAP≥87.3 group (23.4%) than post-MAP<87.3 group (8.1%) (p=0.004), however no significant difference was observed for the eGFR decline of ≥30%.
Conclusion: Poor BP management after combination treatment of SGLT2i and GLP1Ra treatment worsened the renal composite outcomes, especially the progression of albuminuria stage.
K. Kobayashi: None. M. Toyoda: None. D. Kawanami: None. K. Tamura: None.
