Body weight change associated kidney outcomes of sodium–glucose cotransporter new users

• Published in: Diabetes, obesity & metabolism Vol. 26; no. 10; pp. 4535 - 4543
• Main Authors: Jimba, Takahiro, Kaneko, Hidehiro, Azegami, Tatsuhiko, Suzuki, Yuta, Okada, Akira, Ko, Toshiyuki, Fujiu, Katsuhito, Takeda, Norifumi, Morita, Hiroyuki, Hayashi, Kaori, Nishiyama, Akira, Node, Koichi, Yasunaga, Hideo, Takeda, Norihiko, Nangaku, Masaomi, Komuro, Issei
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2024; Wiley Subscription Services, Inc
• Subjects: Age composition; Blood Glucose - analysis; Blood Glucose - drug effects; Blood Glucose - metabolism; Body Mass Index; Body Weight - drug effects; Body weight loss; database research; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Nephropathies - epidemiology; Epidemiology; Epidermal growth factor receptors; Female; Glomerular filtration rate; Glomerular Filtration Rate - drug effects; Glucose; Glycated Hemoglobin - analysis; Glycated Hemoglobin - metabolism; Hemoglobin; Humans; Kidney - drug effects; Kidney - physiopathology; Kidneys; Male; Middle Aged; observational study; pharmaco‐epidemiology; real‐world evidence; Retrospective Studies; Sensitivity analysis; SGLT2 inhibitor; Sodium-glucose cotransporter; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Weight Loss - drug effects; real‐world evidence; SGLT2 inhibitor; pharmaco‐epidemiology; database research; observational study
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/dom.15808

Aim To investigate the clinical significance of body weight changes on kidney outcomes among individuals with diabetes using sodium–glucose cotransporter‐2 (SGLT2) inhibitors. Materials and Methods This is a retrospective cohort study using a nationwide epidemiological database, and we conducted an analysis involving 11 569 individuals with diabetes who were newly prescribed SGLT2 inhibitors. The main outcome was the rate of decline in estimated glomerular filtration rate (eGFR), determined through a linear mixed‐effects model with an unstructured covariance structure. Results The median age of the patients was 52 (Q1–Q3: 47–58) years, and the median fasting plasma glucose and glycated haemoglobin (HbA1c) levels were 144 (Q1–Q3: 124–175) mg/dL and 7.4 (Q1–Q3: 6.8–8.3)%, respectively. The median estimated eGFR was 77.7 (Q1–Q3: 67.2–89.1) mL/min/1.73 m2. The median follow‐up period was 1.7 (Q1–Q3: 1.0–2.6) years. Participants were stratified into three groups based on the body mass index change rate tertiles between baseline and 1 year after (tertile 1: <−4.55%, tertile 2: −4.55% to −1.43%, tertile 3: >−1.43%). The annual change in eGFR was −0.78 (−0.94 to −0.63) mL/min/1.73 m2 in tertile 1, −0.95 (−1.09 to −0.81) mL/min/1.73 m2 in tertile 2, and −1.65 mL/min/1.73 m2 (−1.84 to −1.47) in tertile 3 (pinteraction < 0.001). A variety of sensitivity analyses confirmed the relationship between the 1‐year body mass index decrease and favourable kidney outcomes after SGLT2 inhibitor administration. Conclusions Our analysis of a nationwide epidemiological cohort revealed that kidney outcomes following the initiation of SGLT2 inhibitors would be more favourable, with greater body weight loss observed after the initiation of SGLT2 inhibitors.