Ogata Raisa, Kotaki Takato, Tanaka Kozue, Higuchi Kyoko, Kumano Natsumi, Furukawa Kyoji, Fukumoto Yoshihiro
Department of Pharmacy, Kurume University Hospital, Kurume 830-0011, Japan.
Biostatistics Center, Kurume University, Kurume 830-0011, Japan.
J Clin Med. 2025 Jul 24;14(15):5246. doi: 10.3390/jcm14155246.
: Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has been shown to improve prognosis in patients with chronic heart failure (CHF), in whom a transient decline in the estimated glomerular filtration rate (eGFR), known as the "initial dip," is often observed within the first 1-2 weeks of SGLT2 inhibitor therapy. This study aimed to investigate the factors associated with this initial dip and its impact on long-term renal function in patients with CHF initiating dapagliflozin. : This retrospective study included 123 consecutive CHF patients who were started on dapagliflozin at our institution. The presence of an initial dip was defined as a decrease in the eGFR of ≥5 mL/min/1.73 m within two weeks of initiating therapy. Baseline clinical characteristics and renal function data were analyzed. Older age, hypertension, diabetes mellitus, and a higher baseline eGFR were identified as significant risk factors for the initial dip. Furthermore, both age and the presence of an initial dip were significantly associated with changes in the eGFR at 6 months and 1 year. In patients who experienced an initial dip, the eGFR showed a persistent downward trajectory from the baseline over time. : An initial dip is more likely to occur in older patients and those with hypertension and/or diabetes mellitus. The presence of an initial dip may also influence long-term renal outcomes and could serve as an indicator of long-term renoprotective efficacy.
达格列净是一种钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂，已被证明可改善慢性心力衰竭（CHF）患者的预后，在这些患者中，在SGLT2抑制剂治疗的最初1-2周内，常观察到估计肾小球滤过率（eGFR）出现短暂下降，即所谓的“初始下降”。本研究旨在调查与这种初始下降相关的因素及其对开始使用达格列净的CHF患者长期肾功能的影响。：这项回顾性研究纳入了在我们机构开始使用达格列净的123例连续CHF患者。初始下降的定义为开始治疗后两周内eGFR下降≥5 mL/min/1.73 m²。分析了基线临床特征和肾功能数据。年龄较大、高血压、糖尿病和较高的基线eGFR被确定为初始下降的显著危险因素。此外，年龄和初始下降的存在均与6个月和1年时eGFR的变化显著相关。在经历初始下降的患者中，eGFR随时间从基线开始呈现持续下降趋势。：初始下降更可能发生在老年患者以及患有高血压和/或糖尿病的患者中。初始下降的存在也可能影响长期肾脏结局，并可作为长期肾脏保护疗效的指标。
