Sodium-glucose cotransporter 2 inhibition in primary and secondary glomerulonephritis

• Published in: Nephrology, dialysis, transplantation Vol. 39; no. 2; pp. 328 - 340
• Main Authors: Caravaca-Fontán, Fernando, Stevens, Kate, Padrón, Maite, Huerta, Ana, Montomoli, Marco, Villa, Juan, González, Fayna, Vega, Cristina, López Mendoza, Manuel, Fernández, Loreto, Shabaka, Amir, Rodríguez-Moreno, Antolina, Martín-Gómez, Adoración, Labrador, Pedro J, Molina Andújar, Alicia, Prados Soler, M Carmen, Martín-Penagos, Luis, Yerovi, Estefanía, Medina Zahonero, Laura, De La Flor, José Carlos, Mon, Carmen, Ibernon, Meritxell, Rodríguez Gómez, Astrid, Miquel, Rosa, Sierra, Milagros, Mascarós, Victoria, Luzardo, Leonella, Papasotiriou, Marios, Arroyo, David, Verdalles, Úrsula, Martínez-Miguel, Patricia, Ramírez-Guerrero, Gonzalo, Pampa-Saico, Saúl, Moral Berrio, Esperanza, Canga, José Luis Pérez, Tarragón, Blanca, Fraile Gómez, Pilar, Regidor, Dabaiba, Relea, Javier, Xipell, Marc, Andrades Gómez, Cristina, Navarro, Maruja, Álvarez, Álvaro, Rivas, Begoña, Quintana, Luis F, Gutiérrez, Eduardo, Pérez-Valdivia, Miguel Ángel, Odler, Balazs, Kronbichler, Andreas, Geddes, Colin, Anders, Hans-Joachim, Floege, Jürgen, Fernández-Juárez, Gema, Praga, Manuel
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 31.01.2024
• Subjects: Adult; Cohort Studies; Diabetes Mellitus, Type 2 - complications; Glomerulonephritis - complications; Glomerulonephritis - drug therapy; Glucose; Humans; Kidney Diseases - complications; Middle Aged; Proteinuria - complications; Proteinuria - etiology; Serum Albumin; Sodium; sodium-glucose cotransporter 2 inhibitors; glomerular disease; estimated glomerular filtration rate; body mass index; proteinuria
• ISSN: 0931-0509; 1460-2385; 1460-2385
• DOI: 10.1093/ndt/gfad175

ABSTRACT Background The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management glomerular/systemic autoimmune diseases with proteinuria in real-world clinical settings is unclear. Methods This is a retrospective, observational, international cohort study. Adult patients with biopsy-proven glomerular diseases were included. The main outcome was the percentage reduction in 24-h proteinuria from SGLT2i initiation to 3, 6, 9 and 12 months. Secondary outcomes included percentage change in estimated glomerular filtration rate (eGFR), proteinuria reduction by type of disease and reduction of proteinuria ≥30% from SGLT2i initiation. Results Four-hundred and ninety-three patients with a median age of 55 years and background therapy with renin–angiotensin system blockers were included. Proteinuria from baseline changed by –35%, –41%, –45% and –48% at 3, 6, 9 and 12 months after SGLT2i initiation, while eGFR changed by –6%, –3%, –8% and –10.5% at 3, 6, 9 and 12 months, respectively. Results were similar irrespective of the underlying disease. A correlation was found between body mass index (BMI) and percentage proteinuria reduction at last follow-up. By mixed-effects logistic regression model, serum albumin at SGLT2i initiation emerged as a predictor of ≥30% proteinuria reduction (odds ratio for albumin <3.5 g/dL, 0.53; 95% CI 0.30–0.91; P = .02). A slower eGFR decline was observed in patients achieving a ≥30% proteinuria reduction: –3.7 versus –5.3 mL/min/1.73 m2/year (P = .001). The overall tolerance to SGLT2i was good. Conclusions The use of SGLT2i was associated with a significant reduction of proteinuria. This percentage change is greater in patients with higher BMI. Higher serum albumin at SGLT2i onset is associated with higher probability of achieving a ≥30% proteinuria reduction.