Department of Diabetes and Metabolism, Koseiren Tsurumi Hospital, Oita, Japan.
Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Oita, Japan.
J Diabetes Investig. 2022 Aug;13(8):1330-1338. doi: 10.1111/jdi.13795. Epub 2022 Apr 27.
AIMS/INTRODUCTION: The slope of estimated glomerular filtration rate (eGFR) decline (eGFR slope) in early-stage type 2 diabetes patients might predict the future risk of end-stage renal disease. Type 2 diabetes patients who show rapid progressive eGFR decline are termed rapid decliners. Several studies of rapid decliners have investigated the efficacy of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in patients with advanced renal dysfunction; however, no studies, to our knowledge, have focused on patients with preserved renal function. Therefore, we investigated the efficacy of SGLT2i in rapid decliners with preserved renal function.
This study enrolled type 2 diabetes patients with baseline eGFR ≥60 mL/min/1.73 m who had been treated with SGLT2i for ≥3 years. Among these individuals, we defined those with annual eGFR declines ≥5 mL/min/1.73 m per year before SGLT2i administration as rapid decliners. The primary end-point was the change in eGFR slope after SGLT2i administration.
Among 165 patients treated with SGLT2i for ≥3 years, 21 patients were rapid decliners with preserved renal function. The mean age and eGFR at SGLT2i administration were 58.6 years and 87.1 mL/min/1.73 m , respectively. The mean annual eGFR slope improved significantly in those administered SGLT2i compared with the control group (-1.00 and -4.36 mL/min/1.73 m per year, respectively; P < 0.001). Notably, the steeper the eGFR slope before starting SGLT2i administration, the larger the improvement of eGFR slope, which was independent of the reduction of albuminuria.
Early intervention with SGLT2i may have renoprotective effects in type 2 diabetes patients with rapid decline and preserved renal function.
目的/引言：估算肾小球滤过率（eGFR）下降斜率（eGFR 斜率）在 2 型糖尿病早期患者中可能预测终末期肾脏疾病的未来风险。显示 eGFR 快速下降的 2 型糖尿病患者被称为快速下降者。几项关于快速下降者的研究已经调查了钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）在肾功能不全患者中的疗效；然而，据我们所知，尚无研究关注肾功能正常的患者。因此，我们研究了 SGLT2i 在肾功能正常的快速下降者中的疗效。
本研究纳入了基线 eGFR≥60 mL/min/1.73 m 的 2 型糖尿病患者，这些患者已接受 SGLT2i 治疗≥3 年。在这些患者中，我们将那些在开始 SGLT2i 治疗前每年 eGFR 下降≥5 mL/min/1.73 m 的患者定义为快速下降者。主要终点是 SGLT2i 治疗后 eGFR 斜率的变化。
在 165 名接受 SGLT2i 治疗≥3 年的患者中，有 21 名是肾功能正常的快速下降者。SGLT2i 治疗时的平均年龄和 eGFR 分别为 58.6 岁和 87.1 mL/min/1.73 m。与对照组相比，接受 SGLT2i 治疗的患者 eGFR 斜率的年平均改善显著（分别为-1.00 和-4.36 mL/min/1.73 m/年，P<0.001）。值得注意的是，开始 SGLT2i 治疗前 eGFR 斜率越陡峭，eGFR 斜率的改善越大，这与蛋白尿的减少无关。
早期干预 SGLT2i 可能对 eGFR 快速下降和肾功能正常的 2 型糖尿病患者具有肾脏保护作用。
