Blood pressure after treatment with sodium–glucose cotransporter 2 inhibitors influences renal composite outcome: Analysis using propensity score‐matched models

• Published in: Journal of diabetes investigation Vol. 12; no. 1; pp. 74 - 81
• Main Authors: Kobayashi, Kazuo, Toyoda, Masao, Hatori, Nobuo, Furuki, Takayuki, Sakai, Hiroyuki, Umezono, Tomoya, Ito, Shun, Suzuki, Daisuke, Takeda, Hiroshi, Minagawa, Fuyuki, Degawa, Hisakazu, Yamamoto, Hareaki, Machimura, Hideo, Chin, Keiichi, Hishiki, Toshimasa, Takihata, Masahiro, Aoyama, Kouta, Umezawa, Shinichi, Minamisawa, Kohsuke, Aoyama, Togo, Hamada, Yoshiro, Suzuki, Yoshiro, Hayashi, Masahiro, Hatori, Yutaka, Sato, Kazuyoshi, Miyakawa, Masaaki, Tamura, Kouichi, Kanamori, Akira
• Format: Journal Article
• Language: English
• Published: Japan John Wiley & Sons, Inc 01.01.2021; John Wiley and Sons Inc
• Subjects: Age; Bias; Biomarkers - analysis; Blood Glucose - analysis; Blood Pressure; Clinical medicine; Creatinine; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - metabolism; Diabetes Mellitus, Type 2 - pathology; Diabetic Cardiomyopathies - etiology; Diabetic Cardiomyopathies - prevention & control; Diabetic Nephropathies - drug therapy; Diabetic Nephropathies - etiology; Diabetic Nephropathies - metabolism; Diabetic Nephropathies - pathology; Diabetic nephropathy; Female; Follow-Up Studies; Glomerular Filtration Rate; Glucose; Glycated Hemoglobin - analysis; Humans; Hypertension; Kidney diseases; Male; Middle Aged; Original; Prognosis; Propensity Score; Regression analysis; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - etiology; Renal Insufficiency, Chronic - metabolism; Renal Insufficiency, Chronic - pathology; Retrospective Studies; Sodium-glucose cotransporter; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Sodium–glucose cotransporter 2 Inhibitors; Sodium-glucose cotransporter 2 Inhibitors; Diabetic nephropathy; Blood pressure
• ISSN: 2040-1116; 2040-1124
• DOI: 10.1111/jdi.13318

Aims/Introduction Sodium–glucose cotransporter 2 inhibitors (SGLT2i) improve renal outcome in patients with type 2 diabetes mellitus, but the mechanism is not fully understood. The aim of this retrospective study was to assess the association of achieved blood pressure with renal outcomes in Japanese type 2 diabetes mellitus patients with chronic kidney disease. Materials and Methods We assessed 624 Japanese type 2 diabetes mellitus patients with chronic kidney disease taking SGLT2i for >1 year. The patients were classified as those with post‐treatment mean arterial pressure (MAP) of ≥92 mmHg (n = 344) and those with MAP of <92 mmHg (n = 280) for propensity score matching (1:1 nearest neighbor match with 0.04 of caliper value and no replacement). The end‐point was a composite of progression of albuminuria or a decrease in the estimated glomerular filtration rate by ≥15% per year. Results By propensity score matching, a matched cohort model was constructed, including 201 patients in each group. The incidence of renal composite outcome was significantly lower among patients with MAP of <92 mmHg than among patients with MAP of ≥92 mmHg (n = 11 [6%] vs n = 26 [13%], respectively, P = 0.001). The change in estimated glomerular filtration rate was similar in the two groups; however, the change in the albumin‐to‐creatinine ratio was significantly larger in patients with MAP of <92 mmHg. Conclusions In Japanese type 2 diabetes mellitus patients with chronic kidney disease, blood pressure after SGLT2i administration influences the renal composite outcome. Blood pressure management is important, even during treatment with SGLT2i. Incidence of renal composite outcome and changes in logarithmic value of the albumin‐to‐creatinine ratio and estimated glomerular filtration rate.