Abstract
The purpose of this study was to clarify the profiles of patients in whom SGLT-2 inhibitors are more likely to exert a renal protective effect in clinical practice. We retrospectively analyzed the medical record information of sixty-three type 2 diabetic patients (33 males, 30 females, average age 53.0 ± 13.0 years) who were given usual doses of a SGLT-2 inhibitor. We investigated changes in body weight, blood pressure, glucose metabolism index, lipid metabolism index, estimated glomerular filtration rate (eGFR), and albuminuria (urinary albumin-to-creatinine ratio, UACR) 3 months before and after administration of a SGLT-2 inhibitor. Three months after administration of an SGLT-2 inhibitor, there were improvements in glucose tolerance, weight loss, blood pressure, and lipid indices. In all cases, there was no significant change in eGFR, but UACR decreased significantly. UACR decreased regardless of angiotensin II receptor blocker medication and significantly decreased in nephropathy patients with microalbuminuria or overt albuminuria. UACR decreased only in the group in which blood pressure, body weight, and hemoglobin A1c decreased before and after administration of the SGLT-2 inhibitor. Our study shows that the renoprotective effects of SGLT-2 inhibitors are more likely to be exerted in diabetic nephropathy patients who have advanced to at least microalbuminuria stage, and in addition to direct renal protection, the comprehensive effects of SGLT-2 inhibitors, which lower body weight, blood pressure, and blood glucose, are also important for their renal protection effects.
Highlights
Progression of diabetic nephropathy in type 2 diabetic patients is a factor that determines the prognosis of life
Our study shows that the renoprotective effects of Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are more likely to be exerted in diabetic nephropathy patients who have advanced to at least microalbuminuria stage, and in addition to direct renal protection, the comprehensive effects of SGLT-2 inhibitors, which lower body weight, blood pressure, and blood glucose, are important for their renal protection effects
Renal function and urinary albumin excretion rate are associated with cardiovascular death [7], and renal complications need to be considered when considering the risk of cardiovascular disease (CVD) for type 2 diabetes
Summary
Progression of diabetic nephropathy in type 2 diabetic patients is a factor that determines the prognosis of life. A SGLT-2 inhibitor, canagliflozin, was reported to reduce the relative risk of primary endpoints by 30%, such as progression to end-stage renal failure, doubling of serum creatinine (Cre) levels, and death due to renal disease in patients with type 2 diabetes with chronic kidney disease (CKD) [8]. This is the first large-scale clinical trial with renal outcomes due to SGLT-2 inhibitors as the primary endpoint. This study addresses the growing need to focus on the renal protective effects of SGLT-2 inhibitors in diabetic patients
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