The impact of dynamic kidney function prior to using sodium–glucose cotransporter‐2 inhibitors in type 2 diabetes patients with low‐risk renal disease progression

ABSTRACTAims/IntroductionFew studies have assessed whether dynamic kidney function prior to sodium–glucose cotransporter‐2 inhibitor (SGLT2i) initiation influenced subsequent renal outcomes. Thus, the study aimed to investigate whether combining estimated glomerular filtration rate (eGFR) slope and urinary albumin/creatinine ratio (UACR) change prior to using SGLT2i contributes to subsequent kidney outcomes.Materials and MethodsThis retrospective cohort study utilized data from the Kaohsiung Medical University Hospital Research Database (KMUHRD) in Taiwan. We identified 975 SGLT2i new users with type 2 diabetes from 2016 to 2020, who had an eGFR >60 mL/min/1.73 m2 and UACR <30 mg/g 1 year prior to using SGLT2i. Patients were categorized into four groups based on an eGFR decline rate of 2.5 mL/min/1.73 m2/year and a UACR increase of 30%. The primary study outcomes included a >30% eGFR decline with a drop in eGFR categories and a >43% UACR increase with progression in UACR categories.ResultsAfter SGLT2i treatment, compared with the non‐progressive renal function group, the glomerular injury group significantly lowered the risk of eGFR decline (adjusted hazard ratio [95% CI] 0.384 [0.199, 0.740]) and UACR progression (adjusted hazard ratio [95% CI] 0.514 [0.313, 0.846]). In addition, for those with a major eGFR decline before starting SGLT2i, significant improvements in the eGFR slope (P < 0.05) were observed after the treatment, irrespective of UACR increase.ConclusionsEarly initiation of SGLT2i among type 2 diabetes patients with low‐risk renal disease progression and glomerular injury renal status may prevent them from progressing into chronic kidney disease.