Abstract: TH-PO1054
Association Between Initial Dip and Long-Term Prognosis After Dapagliflozin Administration in Patients with CKD
Session Information
- CKD Progression and Complications: Diagnosis, Prognosis, Risk Factors
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Kawano, Rina, Yokohama Shiritsu Daigaku Fuzoku Shimin Sogo Iryo Center, Yokohama, Kanagawa, Japan
- Hirawa, Nobuhito, Yokohama Shiritsu Daigaku Fuzoku Shimin Sogo Iryo Center, Yokohama, Kanagawa, Japan
- Haruna, Aiko, Yokohama Shiritsu Daigaku Fuzoku Shimin Sogo Iryo Center, Yokohama, Kanagawa, Japan
- Haze, Tatsuya, Yokohama Shiritsu Daigaku, Yokohama, Kanagawa, Japan
- Fujiwara, Akira, Yokohama Shiritsu Daigaku Fuzoku Shimin Sogo Iryo Center, Yokohama, Kanagawa, Japan
- Tamura, Kouichi, Yokohama Shiritsu Daigaku, Yokohama, Kanagawa, Japan
Background
Renoprotective effects of dapagliflozin (sodium glucose transporter 2 inhibitor) have been reported in several randomized controlled trials. The main mechanism considered is correction of hyperfiltration, which can be observed as an acute decline in eGFR referred to as "initial dip". While association between initial dip and long-term renal prognosis have been reported, no consistent conclusions have been reached. We aimed to investigate this relationship in real-world clinical practice.
Methods
We performed a retrospective observational cohort study of patients at Yokohama City University Medical Center in Japan. Patients administered to dapagliflozin between May 2014 thru December 2022 were included. Excluding those with eGFR over 90 or less than 15mL/min/1.73m2 at baseline, history of kidney transplant, dialysis, or cancer, and those with dosage changes of dapagliflozin, 146 patients had complete data at baseline, 4 weeks, and 12 months, and were applicable for this study. We defined initial dip as eGFR decline from baseline to 4 weeks. Chronic change, which reflect long-term renal prognosis, was defined as eGFR decline from 4 weeks to 12 months. The association between initial dip and chronic change was examined using linear regression models. Also, eGFR changes between a year before and after starting dapagliflozin were compared for those whose data were available. (n=74)
Results
Absolute eGFR changes before and after starting dapagliflozin were -4.8±9.6 and -1.5±8.3mL min/1.73m2 per year, respectively. (p<0.05) Long term renoprotective effect of dapagliflozin was observed regardless of initial dip. Furthermore, Pearson's correlation coefficient revealed that the degree of initial dip and chronic change were inversely correlated (r=-0.37, p<0.001). Multivariate regression analysis demonstrated initial dip was an independent determinant factor for chronic change. (p<0.001)
Conclusion
The real-world clinical data showed that the greater the initial dip, significantly smaller the subsequent decline in eGFR. Renoprotective effect of dapagliflozin was observed regardless of initial dip.