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Back off to better blow up: acute GFR decrease at SGLT-2 inhibitor initiation

Maurice Laville1

  • 1INSERM U1060 CarMeN, Université Claude Bernard Lyon 1, Lyon, France.

Kidney International
|March 22, 2021
PubMed

Insights

A temporary drop in kidney function during nephroprotective treatments indicates potential treatment benefits for diabetic kidney disease. This finding applies to sodium-glucose cotransporter 2 inhibition, as seen in the CREDENCE study.

Area of Science:

  • Nephrology
  • Diabetology
  • Pharmacology

Background:

  • A decline in glomerular filtration rate (GFR) is often noted early in nephroprotective therapies.
  • This GFR drop can signify a link between baseline kidney damage and treatment efficacy.
  • Previous observations include protein restriction and renin-angiotensin system blockade.

Purpose of the Study:

  • To investigate if a similar relationship exists with sodium-glucose cotransporter 2 (SGLT2) inhibition.
  • To analyze the post hoc results from the CREDENCE study regarding SGLT2 inhibition and GFR changes.

Main Methods:

  • Post hoc analysis of the Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation (CREDENCE) study.
  • Examination of GFR changes in diabetic patients with chronic kidney disease treated with canagliflozin.

Main Results:

  • The study confirmed that an early drop in GFR is observed with SGLT2 inhibition.
  • This GFR decline correlates with baseline glomerular anomalies and predicts treatment benefit in diabetic kidney disease.

Conclusions:

  • The early GFR drop is a marker of treatment efficacy for SGLT2 inhibitors in diabetic nephropathy.
  • This phenomenon is consistent across different nephroprotective strategies, including SGLT2 inhibition.

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