Patients with a reduction (ΔMAP) of ≤-4 mmHg experienced a lower incidence of adverse renal outcomes compared to those with ΔMAP ≥-4 mmHg.
A total of 624 Japanese type 2 diabetes mellitus patients with chronic kidney disease were analyzed for this study.
Patients were grouped based on the degree of blood pressure reduction after SGLT2 inhibitor treatment.
Those with ΔMAP ≤-4 mmHg had a significantly lower incidence of composite renal outcomes (5.8% vs 15.6%, P = 0.003).
No significant differences were observed in estimated glomerular filtration rates between the two groups.
Patients with ΔMAP ≤-4 mmHg showed significantly larger reductions in urine albumin-to-creatinine ratio (P = 0.005).
Simplified
AIMS/INTRODUCTION: Large-scale clinical trials have reported that, in patients with type 2 diabetes mellitus, sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment affords favorable renal outcomes; the underlying mechanisms, however, remain unclear. Thus, this study investigated how SGLT2 inhibitor-induced changes in the (MAP; denoted as ΔMAP) are associated with renal outcomes in type 2 diabetes mellitus patients with chronic kidney disease (CKD).
MATERIALS AND METHODS: We retrospectively assessed the data of 624 Japanese type 2 diabetes mellitus patients with CKD who had been using SGLT2 inhibitors for >1 year. For propensity score matching (1:1 nearest neighbor match, with caliper value = 0.053, no replacement), patients were categorized into two groups based on the ΔMAP (>-4 mmHg [n = 329] and ≤-4.0 mmHg [n = 295]). Composite albuminuria progression or a ≥15% annual reduction in the estimated glomerular filtration rate was regarded as the end-point.
RESULTS: Per group, 173 propensity-matched patients were compared. Patients with ΔMAP ≤-4 mmHg had a significantly lower incidence of composite renal outcomes than those with ΔMAP ≥-4 mmHg (5.8% [n = 10] vs 15.6% [n = 27], P = 0.003). Although the between-group differences in the estimated glomerular filtration rates were non-significant, patients with a ΔMAP ≤-4 mmHg had significantly larger reductions in the logarithmic urine albumin-to-creatinine ratio (P = 0.005).
CONCLUSIONS: The degree of blood pressure reduction after SGLT2 inhibitor treatment influenced renal composite outcomes in Japanese type 2 diabetes mellitus patients with CKD, confirming the importance of blood pressure management in type 2 diabetes mellitus patients with CKD, even when they are under SGLT2 inhibitor treatment.
Key numbers
5.8%
Lower Incidence of Renal Outcomes
Incidence of renal outcomes in patients with Δ ≤−4 mmHg
15.6%
Higher Incidence of Renal Outcomes
Incidence of renal outcomes in patients with Δ >−4 mmHg
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