Kidney Week

Abstract: SA-OR28

Abrupt Estimated Glomerular Filtration Rate Decline After Initiating Sodium-Glucose Cotransporter-2 Inhibitors Predicts Clinical Outcomes: A Systematic Review

Session Information

• Epidemiology of CKD Progression: Who, Why, and When?
  November 04, 2023 | Location: Room 119, Pennsylvania Convention Center
  Abstract Time: 04:30 PM - 04:39 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Tang, Yu-Shuo, Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

Yu-Shuo Tang, MD

• Chuang, Min-Hsiang, Chi Mei Medical Center, Tainan, Taiwan

Min-Hsiang Chuang,

• Chen, Jui-Yi, Chi Mei Medical Center, Tainan, Taiwan

Jui-Yi Chen,

• Pan, Heng-chih, Chang Gung Memorial Hospital Keelung Branch Library, Keelung, Taiwan

Heng-chih Pan,

• Liao, Hung-Wei, Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

Hung-Wei Liao,

• Chu, Wen-Kai, National Taiwan University Hospital, Taipei, Taiwan

Wen-Kai Chu,

• Cheng, Chung-Yi, Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

Chung-Yi Cheng,

• Wu, Vincent, National Taiwan University Hospital, Taipei, Taiwan

Vincent Wu,

• Heung, Michael, University of Michigan, Ann Arbor, Michigan, United States

Michael Heung,

Background

The initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) typically leads to a reversible initial decline or "dip" in estimated glomerular filtration rate (eGFR). However, the implications of this phenomenon on clinical outcomes are not well-defined.

Methods

We searched MEDLINE, Embase, and Cochrane Library from inception to March 23, 2023 to identify randomized controlled trials and cohort studies comparing kidney and cardiovascular outcomes in patients with and without initial eGFR dip after initiating SGLT2i. Pooled estimates were calculated using random-effect meta-analysis.

Results

We included seven studies in our analysis, which revealed that an initial dip in eGFR following the initiation of SGLT2i was associated with less annual eGFR decline (mean difference: 0.64, 95% confidence interval [CI]: 0.437-0.843 mL/min/1.73m²). The risk of major adverse kidney events was similar between non-dipping and dipping groups but reduced in patients with a 0-10% eGFR dip (hazard ratio [HR]: 0.915, 95% CI: 0.865-0.967). No significant differences were observed in the composite of hospitalized heart failure and cardiovascular death (HR: 0.824, 95% CI: 0.633-1.074), hospitalized heart failure (HR: 1.059, 95% CI: 0.574-1.952), or all-cause mortality (HR: 0.83, 95% CI: 0.589-1.170). However, trial sequential analysis indicated that the required sample size had not been reached to make conclusive claims about cardiovascular and mortality outcomes. The risk of serious adverse events (AEs), discontinuation of SGLT2i due to AEs, kidney-related AEs, acute kidney injury, and volume depletion were similar between the two groups. However, patients with >10% eGFR dip had a higher risk of hyperkalemia compared to the non-dipping group.

Conclusion

The findings of this study suggested that the initial dip in eGFR following the initiation of SGLT2i might be associated with less annual eGFR decline. Additionally, there were no significant differences in the risks of adverse kidney and cardiovascular outcomes between the dipping and non-dipping groups.