Yokouchi Go, Horio Takeshi, Matsumoto Naoki, Fukuda Kohei, Yoshimura Ryutaro, Fujiwara Ryosuke, Matsuoka Yujiro, Sakamoto Yuya, Iwashima Yoshio, Oshiro Yoshiyuki, Fujimoto Kohei, Kasayuki Noriaki
Department of Cardiovascular Medicine, Ishikiriseiki Hospital, Higashiosaka, Japan.
Department of Internal Medicine, Kansai Medical University Kori Hospital, Neyagawa, Japan.
Int J Cardiol Heart Vasc. 2022 Nov 26;43:101152. doi: 10.1016/j.ijcha.2022.101152. eCollection 2022 Dec.
Recent clinical trials have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors have beneficial effects on renal function in heart failure patients. This study confirmed the renoprotective effect of treatment with SGLT2 inhibitors in Japanese patients with chronic heart failure and diabetes and further investigated what cardiac/hemodynamic and noncardiac factors are involved in its effect.
Eligible 50 outpatients with chronic heart failure and type-2 diabetes mellitus chronically taking SGLT2 inhibitors were enrolled. Annual changing rates of estimated glomerular filtration rate (eGFR) were compered before and after treatment with SGLT2 inhibitors and the associations of the change in eGFR slope after SGLT2 inhibitor administration with changes in various clinical and echocardiographic parameters were evaluated.
The mean follow-up periods before and after SGLT2 inhibitor administration were 2.6 and 1.9 years, respectively. Changing rates of eGFR per year were significantly improved after treatment with SGLT2 inhibitors (-5.78 ± 7.67 to -0.43 ± 10.81 mL/min/1.73 m/year, p = 0.006). The daily doses of loop diuretics were not altered after SGLT2 inhibitor administration. Neither decreased body weight nor increased hematocrit was associated with the change in eGFR slope before and after SGLT2 inhibitor administration. While, the decrease in inferior vena cava diameter and the increase in its respiratory collapsibility were significantly correlated with the improvement of eGFR decline slope after SGLT2 inhibitor administration.
Our findings indicated that chronic treatment with SGLT2 inhibitors ameliorated annual decline in eGFR in Japanese patients with chronic heart failure, suggesting the possibility that the improvement of venous congestion was involved in its renoprotective effect.
近期临床试验表明，钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂对心力衰竭患者的肾功能具有有益作用。本研究证实了SGLT2抑制剂治疗对日本慢性心力衰竭合并糖尿病患者的肾脏保护作用，并进一步研究了其作用涉及哪些心脏/血流动力学和非心脏因素。
纳入50例长期服用SGLT2抑制剂的慢性心力衰竭合并2型糖尿病门诊患者。比较SGLT2抑制剂治疗前后估算肾小球滤过率（eGFR）的年变化率，并评估SGLT2抑制剂给药后eGFR斜率变化与各种临床和超声心动图参数变化之间的关联。
SGLT2抑制剂给药前后的平均随访期分别为2.6年和1.9年。SGLT2抑制剂治疗后，eGFR每年的变化率显著改善（从-5.78±7.67降至-0.43±10.81 mL/min/1.73m²/年，p = 0.006）。SGLT2抑制剂给药后袢利尿剂的日剂量未改变。体重减轻和血细胞比容增加均与SGLT2抑制剂给药前后eGFR斜率的变化无关。然而，下腔静脉直径的减小及其呼吸塌陷度的增加与SGLT2抑制剂给药后eGFR下降斜率的改善显著相关。
我们的研究结果表明，SGLT2抑制剂的长期治疗改善了日本慢性心力衰竭患者eGFR的年度下降，提示静脉淤血的改善可能参与了其肾脏保护作用。
