Early reduction in albuminuria is associated with a steeper ‘dip’ in initial estimated glomerular filtration rate but favourable long‐term kidney outcomes in people with diabetes receiving sodium‐glucose cotransporter‐2 inhibitors
Authors' conclusion
Physicians should be vigilant for the potential adverse effects of abrupt eGFR dipping associated with a profound reduction in UACR, despite the favourable long-term kidney outcomes in the population with T2D receiving SGLT2 inhibitor treatment.
Study context
- Population
- People with T2D receiving SGLT2 inhibitors, multicentre healthcare institute in Taiwan, 1 June 2016 to 31 December 2021
- Participants
- 8,310 people
- Exposure
- Categories of early urine albumin-to-creatine ratio (UACR) change after 3 months of SGLT2i treatment
- >30% decreasen = 3,062
- 0%-30% decreasen = 1,743
- 0%-30% increasen = 1,199
- >30% increasen = 2,306
- Outcome
- Acute eGFR change by UACR change group
- Follow-up
- 3 months
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
>30% decrease
−3.6
± 10.9 · mL/min/1.73 m²
0%-30% decrease
−2.0
± 9.5 · mL/min/1.73 m²
0%-30% increase
−1.1
± 8.6 · mL/min/1.73 m²
>30% increase
−0.3
± 9.7 · mL/min/1.73 m²
P < 0.001
Observational data: associations, not effects.
Further findings
>30% initial estimated glomerular filtration rate (eGFR) decline · median 29.0 months
| HR (95% CI) | ||
|---|---|---|
| >30% decreaseAfter multivariate adjustment | 2.68 (1.61–4.47) | |
| 0.20.5125Hazard ratio (log scale) |
Major adverse renal events (MARE) (>50% eGFR reduction or end-stage kidney disease) · median 29.0 months
| HR (95% CI) | ||
|---|---|---|
| >30% decreaseAfter multivariate adjustment | 0.66 (0.48–0.89) | |
| 0.512Hazard ratio (log scale) |
Major adverse cardiovascular events (MACE) or hospitalization for heart failure (HHF) · median 29.0 months
- >30% UACR decline associated with a comparable risk of MACE or HHF
Nonlinear analysis
- Early UACR decline linked to lower risk of MARE but higher risk of initial steep eGFR decline of >30%
Original publication
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