Škrtić Marko, Cherney David Z I, Sridhar Vikas S, Chan Christopher T M, Kitchlu Abhijat
Division of Nephrology, Department of Medicine, Faculty of Medicine, University Health Network, University of Toronto, ON, Canada.
Can J Kidney Health Dis. 2021 Dec 14;8:20543581211065528. doi: 10.1177/20543581211065528. eCollection 2021.
Nephrectomy is the mainstay of treatment for many kidney cancers, but has been correlated with increased incidence of acute kidney injury (AKI) and chronic kidney disease (CKD). Recently, sodium-glucose cotransporter-2 (SGLT2) inhibition has been shown to decrease the incidence of end-stage kidney disease and death in people with type 2 diabetes mellitus (T2D). However, at present, there has been no description of the use of SGLT2 inhibition in patients with T2D and solitary kidney despite the high risk of CKD progression.
To characterize the use of SGLT2 inhibition and kidney function in a series of patients with T2D with prior nephrectomy for renal cell carcinoma (RCC).
Retrospective case series.
University hospital outpatient onco-nephrology clinic.
Patients post-nephrectomy for RCC with T2D who were prescribed an SGLT2 inhibitor.
Serum creatinine, albumin to creatinine ratio (ACR), HgA1c, and blood pressure measurements.
Patients post-nephrectomy with incident use of SGLT2 inhibitor were identified from an existing registry of patients followed in the Onco-Nephrology Clinic at our institution from May 2019 to March 2021. Demographics, medication use, time since nephrectomy, cancer diagnosis, serum creatinine, ACR measurements, and blood pressure measurements were extracted from electronic medical records.
Five patients were identified who had initiated SGLT2 inhibition post-nephrectomy. All patients were male, had T2D, and a prior history of hypertension. Renal cell carcinoma was the clinical indication for nephrectomy in all patients. None of patients were prescribed diuretics, and all were receiving renin-angiotensin system (RAS) inhibition therapies. The time from nephrectomy to SGLT2 inhibitor initiation ranged from 5 to 74 months. Baseline mean estimated glomerular filtration rate (eGFR) values were 49 mL/min/1.73 m (95% confidence interval [CI]: 31.5-66.5), and mean ACRs were 8.7 mg/mmol (95% CI: 0.6-16.9). After 6 months of SGLT2 inhibition, the mean eGFR and ACR values were 58 mL/min/1.73 m (95% CI: 29.7-86.2) and 23.8 mg/mmol (95% CI: 0-60), respectively. After 16 to 18 months of follow-up (4 patients), the mean eGFR was 56 mL/min/1.73 m (95% CI: 37.3-74.7), and mean ACR was 10.5 (95% CI: 0-30.5), similar to baseline values before SGTL2i therapy initiation. At baseline, mean systolic blood pressure was 128 mm Hg (95% CI: 118.3-140.9) and remained similar after 12 months of treatment (mean 131 mm Hg [95% CI: 112.3-149.7]). There were no adverse events related to AKI, electrolyte disturbances, ketoacidosis, or genitourinary infections during the 18-month follow-up period.
Small sample size, lack of a comparison group, and the variable timing of clinical data collection, including eGFR levels following initiation of SGLT2 inhibition.
SGLT2 inhibition is becoming a standard component of nephrology care to reduce kidney function decline, cardiovascular risk, and mortality. To our knowledge, our report is the first to provide longitudinal data on SGLT2 inhibitor usage in patients with T2D and solitary kidneys post-nephrectomy. Larger prospective studies are needed to determine the efficacy and safety of SGLT2 inhibition strategies for kidney protection in patients post-nephrectomy.
肾切除术是许多肾癌治疗的主要手段，但与急性肾损伤（AKI）和慢性肾脏病（CKD）发病率增加相关。最近，已证明钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂可降低2型糖尿病（T2D）患者终末期肾病的发病率和死亡率。然而，目前，尽管CKD进展风险高，但尚无关于T2D合并孤立肾患者使用SGLT2抑制剂的描述。
描述一系列因肾细胞癌（RCC）接受过肾切除术的T2D患者使用SGLT2抑制剂的情况及肾功能。
回顾性病例系列研究。
大学医院门诊肿瘤肾脏病诊所。
因RCC接受肾切除术后并开具SGLT2抑制剂的T2D患者。
血清肌酐、白蛋白与肌酐比值（ACR）、糖化血红蛋白（HgA1c）和血压测量值。
从2019年5月至2021年3月在我们机构肿瘤肾脏病诊所随访的现有患者登记册中，识别出肾切除术后开始使用SGLT2抑制剂的患者。从电子病历中提取人口统计学资料、用药情况、肾切除术后时间、癌症诊断、血清肌酐、ACR测量值和血压测量值。
识别出5例肾切除术后开始使用SGLT2抑制剂的患者。所有患者均为男性，患有T2D，且有高血压病史。肾细胞癌是所有患者肾切除术的临床指征。所有患者均未开具利尿剂，且均接受肾素-血管紧张素系统（RAS）抑制治疗。从肾切除到开始使用SGLT2抑制剂的时间为5至74个月。基线时平均估计肾小球滤过率（eGFR）值为49 mL/min/1.73 m²（95%置信区间[CI]：31.5 - 66.5），平均ACR为8.7 mg/mmol（95% CI：0.6 - 16.9）。SGLT2抑制治疗6个月后，平均eGFR和ACR值分别为58 mL/min/1.73 m²（95% CI：29.7 - 86.2）和23.8 mg/mmol（95% CI：0 - 60）。随访16至18个月（4例患者）后，平均eGFR为56 mL/min/1.73 m²（95% CI：37.3 - 74.7），平均ACR为10.5（95% CI：0 - 30.5），与开始SGLT2抑制剂治疗前的基线值相似。基线时平均收缩压为128 mmHg（95% CI：118.3 - 140.9），治疗12个月后仍相似（平均131 mmHg [95% CI：112.3 - 149.7]）。在18个月的随访期内，未发生与AKI、电解质紊乱、酮症酸中毒或泌尿生殖系统感染相关的不良事件。
样本量小、缺乏对照组以及临床数据收集时间不一致，包括开始SGLT2抑制治疗后的eGFR水平。
SGLT2抑制正成为肾脏科护理的标准组成部分，以减少肾功能下降、心血管风险和死亡率。据我们所知，我们的报告是首个提供T2D合并肾切除术后孤立肾患者使用SGLT2抑制剂纵向数据的报告。需要更大规模的前瞻性研究来确定SGLT2抑制策略对肾切除术后患者肾脏保护的疗效和安全性。
