Retrospective Analysis of the Renoprotective Effects of Long-Term Use of Six Types of Sodium-Glucose Cotransporter 2 Inhibitors in Japanese Patients with Type 2 Diabetes Mellitus and Chronic Kidney Disease

Aim:Sodium-glucose cotransporter 2 inhibitors (SGLT2is) provide renal protection in patients with type 2 diabetes mellitus (T2DM). The aim of this study was to elucidate the renal effects of long-term use of six types of SGLT2is in Japanese patients with T2DM and chronic kidney disease (CKD). Materials and Methods:The Kanagawa Physicians Association maintains a registry of patients who visit their 31 clinics. We retrieved clinical data of patients with T2DM and CKD who were prescribed with SGLT2is for >1 year. Results:A total of 763 patients with a median treatment duration of 33 months were included. The logarithmic value of urine albumin-creatinine ratio (LNACR) decreased significantly from 1.60 +/- 0.65 to 1.51 +/- 0.67. The multiple linear regression analysis revealed that the LNACR at the initiation of treatment, change in (Delta) diastolic blood pressure, and Delta hemoglobin A1c were independently correlated with Delta LNACR (P < 0.001). The decrease in the LNACR was significantly smaller in the patients with estimated glomerular filtration rate (eGFR) [mL/(min center dot 1.73 m(2))] of <60 (P < 0.05). The eGFR decreased from 77.4 +/- 22.3 to 72.7 +/- 22.5 mL/(min center dot 1.73 m(2)) (P < 0.001). The multiple linear regression analysis showed that the LNACR at the initiation of treatment, Delta body weight at the previous survey, Delta eGFR at the previous survey, and the eGFR at the initiation of treatment correlated independently with Delta eGFR during the maintenance period (P < 0.001). Greater changes in the eGFR during the maintenance period were observed in the patients with macroalbuminuria or eGFR of <60 (P < 0.01). Conclusions:The study confirmed that the long-term use of six types of SGLT2i improved the albumin-creatinine ratio (ACR), although the eGFR gradually decreased during the treatment. The change in the ACR was significantly smaller in the patients with eGFR of <60 mL/(min center dot 1.73 m(2)) than in those with eGFR of >60 mL/(min center dot 1.73 m(2)). However, this was a retrospective observational study; further studies are needed to formulate final conclusions.