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Initial eGFR Changes with SGLT2 Inhibitor in Patients With Type 2 Diabetes and Associations With the Risk of Abnormal
Yi-Wei Kao1,2, Tze-Fan Chao3,4, Shao-Wei Chen5,6
1Department of Applied Statistics and Information Science Ming Chuan University Taoyuan City Taiwan.
Journal of the American Heart Association
|April 30, 2024
Summary
Sodium-glucose cotransporter-2 inhibitor (SGLT2i) use in type 2 diabetes patients can cause significant serum potassium changes. A >30% estimated glomerular filtration rate (eGFR) decline after SGLT2i initiation increases risks for both hyperkalemia and hypokalemia.
Area of Science:
- Endocrinology
- Nephrology
- Pharmacology
Background:
- Serum potassium levels are critical in type 2 diabetes management, with both high and low levels posing clinical risks.
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are commonly used for type 2 diabetes but can affect kidney function and electrolytes.
Purpose of the Study:
- To investigate the impact of initial estimated glomerular filtration rate (eGFR) changes on serum potassium homeostasis after SGLT2i initiation in type 2 diabetes patients.
- To assess the risk of hyperkalemia and hypokalemia associated with varying degrees of eGFR decline post-SGLT2i treatment.
Main Methods:
- Retrospective analysis of 5529 type 2 diabetes patients from a Taiwanese healthcare provider.
- Data collected between June 2016 and December 2018, focusing on eGFR and serum potassium levels 4-12 weeks after SGLT2i initiation.
- Multivariate analysis to adjust for confounding factors and assess risks.
Main Results:
- SGLT2i treatment was associated with an average eGFR decline of -3.5 mL/min/1.73 m².
- A significant proportion of patients (5.4%) experienced an eGFR decline greater than 30%.
- Patients with >30% eGFR decline showed higher variability in serum potassium and increased risks of hyperkalemia (aHR=4.59) or hypokalemia (aHR=3.21), as well as increased use of potassium binders (aHR=2.65) or supplements (aHR=1.87).
Conclusions:
- The estimated glomerular filtration rate (eGFR) trough following SGLT2i initiation occurs early.
- Physicians must monitor serum potassium levels closely, especially in patients experiencing a significant eGFR decline after starting SGLT2i therapy.
- Awareness of potential potassium disturbances is crucial for safe SGLT2i use in type 2 diabetes.
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