Department of Applied Statistics and Information Science Ming Chuan University Taoyuan City Taiwan.
Artificial Intelligence Development Center Fu Jen Catholic University Taipei Taiwan.
J Am Heart Assoc. 2024 May 7;13(9):e033236. doi: 10.1161/JAHA.123.033236. Epub 2024 Apr 30.
Both high and low levels of serum potassium measurements are linked with a higher risk of adverse clinical events among patients with type 2 diabetes. The study was aimed at evaluating the implications of the various degrees of initial estimated glomerular filtration rate (eGFR) change on subsequent serum potassium homeostasis following sodium-glucose cotransporter-2 inhibitor (SGLT2i) initiation among patients with type 2 diabetes.
We used medical data from a multicenter health care provider in Taiwan and recruited 5529 patients with type 2 diabetes with baseline/follow-up eGFR data available after 4 to 12 weeks of SGLT2i treatment from June 1, 2016, to December 31, 2018. SGLT2i treatment was associated with an initial mean (SEM) eGFR decline of -3.5 (0.2) mL/min per 1.73 m in overall study participants. A total of 36.7% (n=2028) of patients experienced no eGFR decline, and 57.9% (n=3201) and 5.4% (n=300) of patients experienced an eGFR decline of 0% to 30% and >30%, respectively. Patients with an initial eGFR decline of >30% were associated with higher variability in consequent serum potassium measurement when compared with those without an initial eGFR decline. Participants with a pronounced eGFR decline of >30% were associated with a higher risk of hyperkalemia ≥5.5 (adjusted hazard ratio,4.59 [95% CI, 2.28-9.26]) or use of potassium binder (adjusted hazard ratio, 2.65 [95% CI, 1.78-3.95]) as well as hypokalemia events <3.0 mmol/L (adjusted hazard ratio, 3.21 [95% CI, 1.90-5.42]) or use of potassium supplement (adjusted hazard ratio, 1.87 [95% CI, 1.37-2.56]) following SGLT2i treatment after multivariate adjustment.
Physicians should be aware that the eGFR trough occurs shortly, and consequent serum potassium changes following SGLT2i initiation.
血清钾测量值偏高或偏低与 2 型糖尿病患者发生不良临床事件的风险增加有关。本研究旨在评估 2 型糖尿病患者在起始钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）治疗后 4 至 12 周内，不同程度的初始估算肾小球滤过率（eGFR）变化对随后血清钾稳态的影响。
我们使用了来自台湾一家多中心医疗服务提供者的医疗数据，招募了 5529 名基线/随访时有 eGFR 数据的 2 型糖尿病患者，这些数据是在 2016 年 6 月 1 日至 2018 年 12 月 31 日期间接受 SGLT2i 治疗后 4 至 12 周获得的。SGLT2i 治疗导致总体研究参与者的初始平均（SEM）eGFR 下降 3.5（0.2）mL/min/1.73m。共有 36.7%（n=2028）的患者 eGFR 没有下降，57.9%（n=3201）和 5.4%（n=300）的患者 eGFR 下降 0%至 30%和>30%。与 eGFR 无初始下降的患者相比，eGFR 初始下降>30%的患者随后的血清钾测量值变化更大。eGFR 明显下降>30%的参与者发生高钾血症≥5.5（校正风险比，4.59[95%CI，2.28-9.26]）或使用钾结合剂（校正风险比，2.65[95%CI，1.78-3.95]）以及低钾血症事件<3.0mmol/L（校正风险比，3.21[95%CI，1.90-5.42]）或使用钾补充剂（校正风险比，1.87[95%CI，1.37-2.56]）的风险更高，这与 SGLT2i 治疗后的多变量调整有关。
医生应注意到 eGFR 低谷期发生时间较短，且在 SGLT2i 起始后会发生随后的血清钾变化。
