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Abstract: FR-PO911

SGLT2 Inhibitor Reduces eGFR Variability Leading to Improve eGFR Slope in CKD

Session Information

Category: CKD (Non-Dialysis)

  • 2203 CKD (Non-Dialysis): Mechanisms

Authors

  • Nakano, Yukihito, Kinki Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osakasayama, Osaka, Japan
  • Sakaguchi, Mika, Kinki Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osakasayama, Osaka, Japan
  • Nakatani, Yoshihisa, Kinki Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osakasayama, Osaka, Japan
  • Arima, Shuji, Kinki Daigaku Igakubu Daigakuin Igaku Kenkyuka, Osakasayama, Osaka, Japan
Background

SGLT2 inhibitor has been demonstrated to improve cardiovascular, kidney outcomes in participants with diabetic kidney disease (DKD). However, there remains to be elucidated about mechanisms of efficacy of SGLT2 inhibitor. SGLT-2 inhibition changes intrarenal hemodynamics by tubuloglomerular feedback(TGF) through glucosuria. We examined the estimated glomerular filtration rate (eGFR) slope and variability before and after SGLT2 inhibitor treatment.

Methods

We obtained eGFR values from 77 participants diagnosed DKD who have visited our hospital over two years. To estimate eGFR change after SGLT2 inhibitor treatment reliably, we selected eGFR values at least 3 months after the SGLT2 inhibitor prescription. Using a standard linear regression model for individuals, we stored the slope coefficient, the expected eGFR, and the regression residual, respectively. eGFR variability was calculated as ‘(mean sqrt [residual of eGFR]2)/(mean observed eGFR) × 100 (%)’.

Results

Of 77 participants, median age was 68 years (IQR 55 to 73) and 71.4% were male. 25 (32.5%) participants had a history of cardiovascular disease. Median eGFR at SGLT2 inhibitor prescription was 46 ml/min/1.73m2 (IQR 32 to 67) and median eGFR slope was 0.99 ml/min/1.73m2 per year (IQR -4.45 to 0.58). eGFR variability was 5.87% (IQR 4.44 to 7.64). The initial dip was observed in about 80% of participants. We divided the participants into responders and non-responders by the difference of eGFR slope before and after SGLT2 inhibitor initiation. Responders significantly had a reduction in eGFR variability than non-responders (-1.16% vs -0.28%, p<0.05). Also, eGFR variability negatively correlated with the degree of changes in eGFR slope (ρ=0.31, p<0.01).

Conclusion

We confimed that the initial dip is usually observed in CKD. SGLT2 inhibitor is supposed to be optimize the TGF. Our results suggest that SGLT2 inhibitor stabilizes eGFR by reduces eGFR variability through TGF.