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Kidney Week

Abstract: TH-PO1149

Real-World Effectiveness of SGLT2 Inhibitors on the Progression of Kidney Disease in Non-Diabetic CKD Patients with and Without Albuminuria

Session Information

  • Late-Breaking Posters
    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

  • Nakhleh, Afif, Maccabi Healthcare Services, Tel Aviv, Israel
  • Gazit, Sivan, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
  • Gross, Adi, Medical Affairs, AstraZeneca, Kfar Saba, Israel
  • Yarden, Adva, Medical Affairs, AstraZeneca, Kfar Saba, Israel
  • Shehadeh, Naim, Maccabi Healthcare Services, Tel Aviv, Israel
  • Abdul-Ghani, Muhammad, Maccabi Healthcare Services, Tel Aviv, Israel
  • Melzer Cohen, Cheli, Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
Background

In renal outcome trials, SGLT2 inhibition slows the progression of kidney injury in patients with & without type 2 diabetes (T2D). It is imperative to examine the renal effects of SGLT2 inhibition specifically among patients with chronic kidney disease (CKD) without T2D in a real-world setting.

Methods

We collected de-identified data on adult patients without diabetes who had an estimated glomerular filtration rate (eGFR) of 25-60 ml/min/1.73m2 & initiated SGLT2 inhibitor (SGLT2i) dapagliflozin or empagliflozin between 9/2020-11/2022 in Maccabi Healthcare Services, a large Israeli health maintenance organization. We assessed the effect of SGLT2i on renal function, measured as the change in eGFR slope over time. The index date was defined as the date of the first dispensing of SGLT2i. Annual baseline slope was calculated by using all eGFR measurements within 2 years prior to index date (median of 7 measurements), while annual follow-up slope was calculated by using all evaluations during 90-900 days after index date (median of 5 measurements). For both periods, at least 180 days between first & last eGFR measurements were required. Paired t-test was used to compare differences between baseline & follow-up annual slopes.

Results

This analysis included 354 patients with CKD without T2D who received SGLT2i & were followed for a median of 527 days. The mean age was 72.8±11.8, 26% were women & 91% used renin-angiotensin system blockade. The mean eGFR was 45.4±9.5 ml/min/1.73m2.
146 (41%) of participants had urinary albumin-to-creatinine ratio (UACR)<30mg/g, 81 (23%) had UACR of 30-300mg/g, 74 (21%) had UACR>300mg/g & 53 (15%) had no UACR evaluation within 1 year before index date. The slope of eGFR over time was -5.6±7.7 ml/min/1.73m2 per year at baseline & it was improved to -1.7±6.8 ml/min/1.73m2 per year after SGLT2i administration, (p<0.001). This effect was independent of UACR (Table 1).

Conclusion

In real-world study of patients with CKD without T2D, SGLT2 inhibition was associated with a slower rate of kidney function decline, regardless of baseline UACR levels.

Table 1
UACR (mg/g)No. of patientsBaseline SlopeTherapy SlopeP value
<30146-5.9±9.2-0.8±6.6<0.001
30-30081-5.5±7.4-1.7±8.0<0.005
>30074-5.0±5.2-3.5±4.90.09

Funding

  • Commercial Support – AstraZeneca