Initial dip predicts renal protective effects after the administration of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and chronic kidney disease with normoalbuminuria

INTRODUCTION: We investigated the renoprotective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on renal function in patients with type 2 diabetes and chronic kidney disease (CKD) with normoalbuminuria. METHODS: A retrospective review of clinical records of Japanese participants with type 2 diabetes and CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m(2)) with normoalbuminuria (urine albumin to creatinine ratio < 30 mg/g Cr and/or urinary protein to creatinine ratio < 150 mg/g Cr) was conducted. Participants were categorized into two groups depending on whether they had started using SGLT2is. The main study outcome was a comparison of the change in renal function evaluated by eGFR after 1 year between the two groups. Then, we identified predictors that were associated with the outcome. RESULTS: Among the 46 participants, 21 were treated with SGLT2is (SGLT2 group) and 25 were treated with other antidiabetic medications (control group). Although eGFR was significantly decreased at 1 year in the control group, the decline in eGFR was not observed in the SGLT2 group. The decrease in eGFR was significantly smaller in the SGLT2 group than in the control group. Additionally, multiple linear regression analysis showed that an initial dip was an independent factor associated with the worsening of renal function in the SGLT2 group. CONCLUSIONS: Although more favorable effects of SGLT2is on renal function were observed in patients with type 2 diabetes and CKD with normoalbuminuria, the higher initial dip was a possible marker of worsening renal function after the initiation of SGLT2is.