Committee of Hypertension and Kidney disease, Kanagawa Physicians Association, Yokohama, Japan.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
J Diabetes Investig. 2021 Aug;12(8):1408-1416. doi: 10.1111/jdi.13491. Epub 2021 Feb 1.
AIMS/INTRODUCTION: Large-scale clinical trials have reported that, in patients with type 2 diabetes mellitus, sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment affords favorable renal outcomes; the underlying mechanisms, however, remain unclear. Thus, this study investigated how SGLT2 inhibitor-induced changes in the mean arterial pressure (MAP; denoted as ΔMAP) are associated with renal outcomes in type 2 diabetes mellitus patients with chronic kidney disease (CKD).
We retrospectively assessed the data of 624 Japanese type 2 diabetes mellitus patients with CKD who had been using SGLT2 inhibitors for >1 year. For propensity score matching (1:1 nearest neighbor match, with caliper value = 0.053, no replacement), patients were categorized into two groups based on the ΔMAP (>-4 mmHg [n = 329] and ≤-4.0 mmHg [n = 295]). Composite albuminuria progression or a ≥15% annual reduction in the estimated glomerular filtration rate was regarded as the end-point.
Per group, 173 propensity-matched patients were compared. Patients with ΔMAP ≤-4 mmHg had a significantly lower incidence of composite renal outcomes than those with ΔMAP ≥-4 mmHg (5.8% [n = 10] vs 15.6% [n = 27], P = 0.003). Although the between-group differences in the estimated glomerular filtration rates were non-significant, patients with a ΔMAP ≤-4 mmHg had significantly larger reductions in the logarithmic urine albumin-to-creatinine ratio (P = 0.005).
The degree of blood pressure reduction after SGLT2 inhibitor treatment influenced renal composite outcomes in Japanese type 2 diabetes mellitus patients with CKD, confirming the importance of blood pressure management in type 2 diabetes mellitus patients with CKD, even when they are under SGLT2 inhibitor treatment.
目的/引言：大型临床试验报告称，在 2 型糖尿病患者中，钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂治疗可带来有利的肾脏结局；然而，其潜在机制仍不清楚。因此，本研究旨在探讨 SGLT2 抑制剂治疗后平均动脉压（MAP；表示为ΔMAP）的变化与 2 型糖尿病伴慢性肾脏病（CKD）患者的肾脏结局之间的关系。
我们回顾性评估了 624 例使用 SGLT2 抑制剂超过 1 年的日本 2 型糖尿病伴 CKD 患者的数据。为了进行倾向评分匹配（1:1 最近邻匹配，卡尺值=0.053，无替换），根据ΔMAP（>-4mmHg[n=329]和≤-4.0mmHg[n=295]）将患者分为两组。复合白蛋白尿进展或估算肾小球滤过率每年下降≥15%被视为终点。
每组比较了 173 例匹配的患者。ΔMAP≤-4mmHg 的患者复合肾脏结局的发生率明显低于ΔMAP≥-4mmHg 的患者（5.8%[n=10]vs 15.6%[n=27]，P=0.003）。虽然两组间估算肾小球滤过率的差异无统计学意义，但ΔMAP≤-4mmHg 的患者对数尿白蛋白与肌酐比值的下降幅度明显更大（P=0.005）。
SGLT2 抑制剂治疗后血压降低的程度影响日本 2 型糖尿病伴 CKD 患者的肾脏复合结局，证实了即使在使用 SGLT2 抑制剂治疗时，对 CKD 患者的血压管理也很重要。
