Abstract: SA-PO0245
One-Year eGFR Trajectories and Kidney Outcomes Following SGLT2 Inhibitor Use: A Real-World Study
Session Information
- Pharmacology
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
- 2000 Pharmacology (PharmacoKinetics, -Dynamics, -Genomics)
Authors
- Hong, Yu-Cyuan, Division of Nephrology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
- Li, Wen-Yi, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan Province, Taiwan
- Chang, Yi-Ching, Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Chiang, Hsiu-Yin, Big Data Center, China Medical University Hospital, Taichung, Taiwan
- Kuo, Chin-Chi, Big Data Center, China Medical University Hospital, Taichung, Taiwan
Background
An initial estimated glomerular filtration rate (eGFR) decline after sodium-glucose cotransporter-2 inhibitors (SGLT2i) treatment is well documented and considered beneficial in trials, but its real-world impact, particularly for declines >10%, remains unclear. This prompted our study of one-year eGFR trajectories and kidney outcomes following SGLT2i initiation.
Methods
We conducted a retrospective cohort study of 3,770 patients aged 18–89 years who were first prescribed SGLT2i at the iHi Platform of China Medical University Hospital between 2015 and 2021, excluding those with end-stage kidney disease (ESKD), recent nephrotoxic exposure (±90 days), missing serum creatinine data, or SGLT2i use <80% during the 90-day period. We categorized patients into four groups based on eGFR changes during the first three months: >10% increase, 0–10% increase, 0–10% decline, and >10% decline. The primary exposure was defined as a >10% eGFR decline. The one-year composite kidney outcome (CKO) included sustained eGFR decline >40%, doubling of serum creatinine, or progression to ESKD. Associations were analyzed using multiple Cox regression with propensity score covariate adjustment.
Results
The median age was 60.7 years (IQR 51.2–68.6); 94.3% had diabetes, and 22.1% had chronic kidney disease (CKD). The median follow-up eGFR measurement frequency was four times. The four eGFR variation groups were: 370 (9.8%) with >10% increase, 1,020 (27.1%) with 0–10% increase, 1,520 (40.3%) with 0–10% decline, and 860 (22.8%) with >10% decline. The corresponding median eGFRs were 66.7, 88.9, 91.8, and 72.2 ml/min/1.73m2, with CKD prevalence of 37.3%, 14.5%, 16.6%, and 34.4%, respectively. The one-year incidence proportion of CKO was 7.1% in patients with an initial eGFR dip >10%, compared to 0.8% in those without such a dip. Patients with an initial eGFR dip >10% had a significantly higher risk of one-year CKO compared to those without (adjusted hazard ratio [aHR]: 5.66; 95% CI: 3.49-9.18), particularly in patients without CKD (aHR 11.40; 5.36-24.21), p-interaction 0.003).
Conclusion
An initial eGFR dip >10% following SGLT2i use in real-world settings may not be a risk-free signal for adverse kidney outcomes, particularly in non-CKD populations, and warrants further investigation.
Funding
- Government Support – Non-U.S.