Early eGFR decline after SGLT2i initiation: knowns and unknowns

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are recognized for improving renal and cardiovascular outcomes.
• An acute decline in glomerular filtration rate (GFR) is a common observation upon initiating SGLT2i therapy.
• The clinical implications of this initial GFR dip are not fully understood.

Purpose of the Study:

• To identify factors associated with the initial decline in estimated GFR (eGFR) after starting empagliflozin.
• To analyze the subsequent kidney function trajectory following SGLT2i initiation.
• To investigate the association between the odds of an initial eGFR dip and long-term cardiovascular and kidney outcomes.

Main Methods:

• Retrospective analysis of patient data from a clinical trial comparing empagliflozin and placebo.
• Statistical modeling to assess factors related to the initial eGFR decline.
• Survival analysis to evaluate the association of eGFR dip with long-term outcomes.

Main Results:

• Specific patient characteristics were associated with a greater likelihood of experiencing an initial eGFR decline.
• The trajectory of kidney function varied among patients who experienced an eGFR dip compared to those who did not.
• An initial eGFR dip was not consistently associated with adverse long-term cardiovascular or kidney outcomes in this cohort.

Conclusions:

• The acute decline in eGFR following SGLT2i initiation is influenced by various factors.
• The clinical significance of the initial eGFR dip may not be a reliable predictor of long-term adverse events.
• Further research is warranted to fully elucidate the implications of SGLT2i-induced eGFR changes.