Heterogeneous Kidney Patterns in Diabetic Patients Following SGLT2 Inhibitor Use.

Area of Science:

• Nephrology
• Endocrinology
• Diabetology

Background:

• Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are known to slow kidney disease progression in diabetic patients.
• However, patient responses to SGLT2is can be heterogeneous, with some experiencing rapid kidney function decline.
• This study investigates these varied responses and identifies contributing factors.

Purpose of the Study:

• To analyze kidney function trajectories in type 2 diabetes patients treated with SGLT2is.
• To identify distinct patterns of estimated glomerular filtration rate (eGFR) changes.
• To determine factors associated with rapid eGFR decline.

Main Methods:

• Retrospective cohort study of 66,375 type 2 diabetes patients, with 5,209 on SGLT2is.
• Latent class linear mixed model analysis of eGFR trajectories in 4,185 patients over a median of 29.7 months.
• Multinomial logistic regression to identify factors associated with eGFR patterns.

Main Results:

• Four distinct eGFR trajectory patterns were identified: stable high, stable low, rapidly declining high, and rapidly declining low.
• Rapid eGFR decline was observed in 2.6% of patients, more common in younger individuals with albuminuria and hypoalbuminemia.
• Patients with rapidly declining eGFR faced higher risks of hospitalization and death.

Conclusions:

• Significant heterogeneity exists in eGFR trajectories among diabetic patients treated with SGLT2is.
• Early identification of patients at risk for rapid eGFR decline is crucial.
• Optimizing treatment strategies and providing timely warnings can improve patient outcomes.