Ryo Shibata1, Kensei Taguchi2, Yusuke Kaida1, Kei Fukami1. 1. Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume City, Fukuoka, Japan. 2. Division of Nephrology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-Machi, Kurume City, Fukuoka, Japan. taguchi_kensei@kurume-u.ac.jp.
Abstract
BACKGROUND: Dapagliflozin (DAPA), a sodium-glucose transporter 2 inhibitor (SGLT2i), attenuates kidney outcomes in patients with not only diabetes mellitus (DM) but also chronic kidney disease (CKD). SGLT2i-derived initial dip in estimated glomerular filtration rate (eGFR) has been considered to reduce excess glomerular pressure, followed by renal protection in patients with DM. However, whether DAPA confers the eGFR dip and its independent determinants for CKD patients without DM are unclear. METHODS: A total of 126 patients with CKD treated with 10 mg DAPA daily was retrospectively registered. After participants with missing data and DM were excluded, 51 participants were enrolled. RESULTS: An initial eGFR dip was observed 1 month after initiation of DAPA, which was sustained until 2 months. DAPA did not affect urinary protein excretion; however, serum uric acid was decreased, while hemoglobin level was increased. Multiple regression analysis revealed that eGFR at baseline was the only independent determinant of the initial dip of eGFR. The patients currently showing exacerbation of glomerular hyperfiltration exhibited the larger initial eGFR dip rather than those showing progressive renal dysfunction. The patients meeting exclusion criteria of DAPA-CKD trial exhibited same degree of the initial eGFR dip as others. CONCLUSIONS: DAPA causes an initial dip of eGFR in CKD patients without DM at 1 month after starting DAPA treatment. A higher eGFR at baseline predicts a large initial eGFR dip, which might be linked to the subsequent recovery in eGFR in CKD patients without DM.
BACKGROUND: Dapagliflozin (DAPA), a sodium-glucose transporter 2 inhibitor (SGLT2i), attenuates kidney outcomes in patients with not only diabetes mellitus (DM) but also chronic kidney disease (CKD). SGLT2i-derived initial dip in estimated glomerular filtration rate (eGFR) has been considered to reduce excess glomerular pressure, followed by renal protection in patients with DM. However, whether DAPA confers the eGFR dip and its independent determinants for CKD patients without DM are unclear. METHODS: A total of 126 patients with CKD treated with 10 mg DAPA daily was retrospectively registered. After participants with missing data and DM were excluded, 51 participants were enrolled. RESULTS: An initial eGFR dip was observed 1 month after initiation of DAPA, which was sustained until 2 months. DAPA did not affect urinary protein excretion; however, serum uric acid was decreased, while hemoglobin level was increased. Multiple regression analysis revealed that eGFR at baseline was the only independent determinant of the initial dip of eGFR. The patients currently showing exacerbation of glomerular hyperfiltration exhibited the larger initial eGFR dip rather than those showing progressive renal dysfunction. The patients meeting exclusion criteria of DAPA-CKD trial exhibited same degree of the initial eGFR dip as others. CONCLUSIONS: DAPA causes an initial dip of eGFR in CKD patients without DM at 1 month after starting DAPA treatment. A higher eGFR at baseline predicts a large initial eGFR dip, which might be linked to the subsequent recovery in eGFR in CKD patients without DM.
Authors: David Z I Cherney; Bruce A Perkins; Nima Soleymanlou; Maria Maione; Vesta Lai; Alana Lee; Nora M Fagan; Hans J Woerle; Odd Erik Johansen; Uli C Broedl; Maximilian von Eynatten Journal: Circulation Date: 2013-12-13 Impact factor: 29.690
Authors: Thaminda Liyanage; Toshiharu Ninomiya; Vivekanand Jha; Bruce Neal; Halle Marie Patrice; Ikechi Okpechi; Ming-hui Zhao; Jicheng Lv; Amit X Garg; John Knight; Anthony Rodgers; Martin Gallagher; Sradha Kotwal; Alan Cass; Vlado Perkovic Journal: Lancet Date: 2015-03-13 Impact factor: 79.321
Authors: Christoph Wanner; Silvio E Inzucchi; John M Lachin; David Fitchett; Maximilian von Eynatten; Michaela Mattheus; Odd Erik Johansen; Hans J Woerle; Uli C Broedl; Bernard Zinman Journal: N Engl J Med Date: 2016-06-14 Impact factor: 91.245
Authors: Hiddo J L Heerspink; Bergur V Stefánsson; Ricardo Correa-Rotter; Glenn M Chertow; Tom Greene; Fan-Fan Hou; Johannes F E Mann; John J V McMurray; Magnus Lindberg; Peter Rossing; C David Sjöström; Roberto D Toto; Anna-Maria Langkilde; David C Wheeler Journal: N Engl J Med Date: 2020-09-24 Impact factor: 91.245
Authors: Darren K McGuire; Weichung J Shih; Francesco Cosentino; Bernard Charbonnel; David Z I Cherney; Samuel Dagogo-Jack; Richard Pratley; Michelle Greenberg; Shuai Wang; Susan Huyck; Ira Gantz; Steven G Terra; Urszula Masiukiewicz; Christopher P Cannon Journal: JAMA Cardiol Date: 2021-02-01 Impact factor: 14.676
Authors: Benjamin Bowe; Yan Xie; Tingting Li; Ali H Mokdad; Hong Xian; Yan Yan; Geetha Maddukuri; Ziyad Al-Aly Journal: JAMA Netw Open Date: 2018-11-02