Jimba Takahiro, Kaneko Hidehiro, Azegami Tatsuhiko, Suzuki Yuta, Okada Akira, Ko Toshiyuki, Fujiu Katsuhito, Takeda Norifumi, Morita Hiroyuki, Hayashi Kaori, Nishiyama Akira, Node Koichi, Yasunaga Hideo, Takeda Norihiko, Nangaku Masaomi, Komuro Issei
Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
Diabetes Obes Metab. 2024 Oct;26(10):4535-4543. doi: 10.1111/dom.15808. Epub 2024 Jul 28.
To investigate the clinical significance of body weight changes on kidney outcomes among individuals with diabetes using sodium-glucose cotransporter-2 (SGLT2) inhibitors.
This is a retrospective cohort study using a nationwide epidemiological database, and we conducted an analysis involving 11 569 individuals with diabetes who were newly prescribed SGLT2 inhibitors. The main outcome was the rate of decline in estimated glomerular filtration rate (eGFR), determined through a linear mixed-effects model with an unstructured covariance structure.
The median age of the patients was 52 (Q1-Q3: 47-58) years, and the median fasting plasma glucose and glycated haemoglobin (HbA1c) levels were 144 (Q1-Q3: 124-175) mg/dL and 7.4 (Q1-Q3: 6.8-8.3)%, respectively. The median estimated eGFR was 77.7 (Q1-Q3: 67.2-89.1) mL/min/1.73 m. The median follow-up period was 1.7 (Q1-Q3: 1.0-2.6) years. Participants were stratified into three groups based on the body mass index change rate tertiles between baseline and 1 year after (tertile 1: <-4.55%, tertile 2: -4.55% to -1.43%, tertile 3: >-1.43%). The annual change in eGFR was -0.78 (-0.94 to -0.63) mL/min/1.73 m in tertile 1, -0.95 (-1.09 to -0.81) mL/min/1.73 m in tertile 2, and -1.65 mL/min/1.73 m (-1.84 to -1.47) in tertile 3 (p < 0.001). A variety of sensitivity analyses confirmed the relationship between the 1-year body mass index decrease and favourable kidney outcomes after SGLT2 inhibitor administration.
Our analysis of a nationwide epidemiological cohort revealed that kidney outcomes following the initiation of SGLT2 inhibitors would be more favourable, with greater body weight loss observed after the initiation of SGLT2 inhibitors.
探讨使用钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂的糖尿病患者体重变化对肾脏结局的临床意义。
这是一项使用全国性流行病学数据库的回顾性队列研究，我们对11569例新开具SGLT2抑制剂处方的糖尿病患者进行了分析。主要结局是估计肾小球滤过率（eGFR）的下降率，通过具有非结构化协方差结构的线性混合效应模型确定。
患者的中位年龄为52岁（四分位间距：47 - 58岁），空腹血糖和糖化血红蛋白（HbA1c）的中位水平分别为144mg/dL（四分位间距：124 - 175mg/dL）和7.4%（四分位间距：6.8 - 8.3%）。估计的eGFR中位值为77.7mL/min/1.73m²（四分位间距：67.2 - 89.1mL/min/1.73m²）。中位随访期为1.7年（四分位间距：1.0 - 2.6年）。根据基线至1年后的体重指数变化率三分位数将参与者分为三组（三分位数1：< - 4.55%，三分位数2：- 4.55%至- 1.43%，三分位数3：> - 1.43%）。三分位数1中eGFR的年变化为- 0.78（- 0.94至- 0.63）mL/min/1.73m²，三分位数2中为- 0.95（- 1.09至- 0.81）mL/min/1.73m²，三分位数3中为- 1.65mL/min/1.73m²（- 1.84至- 1.47）（p < 0.001）。各种敏感性分析证实了SGLT2抑制剂给药后1年体重指数下降与良好肾脏结局之间的关系。
我们对全国性流行病学队列的分析表明，开始使用SGLT2抑制剂后的肾脏结局会更有利，且开始使用SGLT2抑制剂后观察到体重减轻更多。
