Abstract: FR-PO230
Effects of Blood Pressure After Sodium-Glucose Cotransporter 2 Inhibitor Treatment on Renal Composite Outcomes in Japanese Type 2 Diabetes Patients with CKD
Session Information
- Diabetic Kidney Disease: Advancing Treatment
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diabetic Kidney Disease
- 602 Diabetic Kidney Disease: Clinical
Authors
- Kobayashi, Kazuo, Kanagawa Physicians Association, Yokohama,Kanagawa Prefecture, Japan
- Toyoda, Masao, Tokai University School of Medicine, Isehara, KANAGAWA, Japan
- Sakai, Hiroyuki, Kanagawa Physicians Association, Yokohama, Japan
- Furuki, Takayuki, Kanagawa Physicians Association, Yokohama,Kanagawa Prefecture, Japan
- Hatori, Nobuo, Kanagawa Physicians association, Odawara, Japan
- Tamura, Kouichi, Yokohama City University Graduate School of Medicine, Yokohama, Japan
Background
Previous large clinical trials using sodium–glucose cotransporter 2 inhibitors (SGLT2is) demonstrated improved renal outcomes in patients with type 2 diabetes mellitus (T2DM). Pleiotropic effects are considered important, but the mechanisms involved are not fully understood. The aim of this study is to clarify the mechanism by who the blood pressure (BP) after SGLT2i treatment influence renal composite outcomes in Japanese T2DM patients with chronic kidney disease (CKD).
Methods
We retrospectively assessed 626 Japanese T2DM patients with CKD who underwent SGLT2i treatment for over 1 year. The renal composite endpoint was the progression of albuminuria stage or a decrease in the estimated glomerular filtration rate (eGFR) by ≥15% per year. For comparative analyses, we included patients comprising those with >92 mmHg in mean arterial pressure (MAP) after SGLT2i treatment and those with <92mmHg in MAP and used propensity score matching methods to address the imbalances in age, sex, body weight, hemoglobin A1c, eGFR, and urinary albumin–creatinine ratio (ACR) at baseline. The propensity score matching used an algorithm involving a 1:1 ratio of the nearest neighbor match with a ±0.025 caliper and no replacement.
Results
The standardized differences in the backgrounds for propensity-matched patients were calculated to be <0.1. Comparisons between the 210 propensity-matched patients in each group were performed. The incidence of renal composite outcomes was occurred in 42 cases totally and it was significantly lower in patients with <92 mmHg in MAP after SGLT2i treatment than in those with ≥92 mmHg in MAP (6.2% [n=13]and 16.0%[n=29], respectively, p=0.009 by chi-square test). The estimated hazard ratio for the renal composite outcomes, determined using a Cox proportional hazards model, was 1.361 (95% confidence interval, 1.011 to 1.832, p=0.042）in patients with ≥92 mmHg in MAP. There was no significant difference in the logarithmic value of ACR between the two groups.
Conclusion
The BP after SGLT2i treatment influenced renal composite outcomes in Japanese T2DM patients with CKD. These results reaffirmed the importance of BP management in T2DM patients with CKD, even during SGLT2i treatment.