What does this research mean for the field?

Individualized eGFR slope analysis reveals that while SGLT2 inhibitor therapy significantly slows renal decline in most patients with type 2 diabetes and advanced CKD, particularly rapid decliners, a subset of patients experiences worsening trajectories, highlighting the need for personalized therapeutic intensification. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research aims to evaluate the impact of individualized eGFR slope analysis on therapeutic optimization in advanced chronic kidney disease (CKD).

June 7, 2026

1838-P: Individualized Slope Analysis: Optimizing Reno-Protective Pillars of Therapy

Key Points

This research aims to evaluate the impact of individualized eGFR slope analysis on therapeutic optimization in advanced chronic kidney disease (CKD).
Retrospective analysis of eGFR slopes in 75 individuals with type 2 diabetes and advanced CKD before and after adding SGLT2i±GLP-1RA.
Calculation of baseline and post-intervention eGFR slopes over a defined duration.
Assessment of response variation based on individual patient eGFR trajectories.
Average eGFR slope improved from -3.7 to -1.1 mL/min/1.73m2/year after SGLT2i initiation (P<0.001).
In 80% of participants, slopes significantly improved; 20% experienced further decline (P<0.01).
Rapid decliners showed remarkable improvement with combined GLP-1RA therapy, with eGFR slopes moving from -18.9 to -1.2 mL/min/1.73m2/year (P<0.01).

Abstract

Introduction and Objective: In addition to albuminuria, eGFR slope has been shown to be a surrogate marker to subsequent progression to end-stage renal disease. Pursuing for the renal protection, therapeutic optimization is needed in each person. We retrospectively analyzed eGFR slope in each person and how optimization should be needed in very diverse eGFR slope trajectories. Methods: Slopes were assessed in persons (n=75) with type 2 diabetes with advanced CKD (stage 3-4) before and after adding SGLT2i±GLP-1RA. Baseline slopes were calculated from 45.6±20.0months. And after adding SGLT2i, slopes were calculated from 64.1±30.6months. Results: 1) At the time of SGLT2i initiation, mean age was 69.1±12.2yrs-old, duration of diabetes was 15.4±10.1years, and eGFR level was 46.1±14.1mL/min/1.73m2. Time axis averaged eGFR slope was improved from -3.7 to -1.1mL/min/1.73m2/year after adding SGLT2i. 2) But individually calculated baseline slopes widely varied from -66.2 to +0.8mL/min/1.73m2/year. In 80% (60/75) of persons, slopes were improved from -7.5±9.7 to -0.7±2.8mL/min/1.73m2/year (P0.001) after adding SGLT2i. But in 20% (15/75), they worsened from -1.6±2.0 to -3.1±3.4mL/min/1.73m2/year (P0.01), despite equally combined use of GLP-1RA (55%, 53%). 3) Rapid decliners (defined as baseline slope was greater than -10.0ml/min/1.73m2/y) existed in 17% (13/75). Half of them (7/13) had nephrotic state, but slopes were remarkably improved from -18.9±16.4 to -1.2±3.2ml/min/1.73m2/year (P0.01) with combined use of GLP-1RA in 85%. On different sub-analysis: stepwise use of GLP-1RA then SGLT2i (n=11), slopes were improved from -16.7±19.8 to -5.0±5.8 (P0.05), then improved to -2.5±3.8mL/min/1.73m2 (P0.03) compared to the baseline. 4) Histogram of the individual eGFR slopes: distribution showed notable improvement in rapid decliners. Conclusion: Intensification by multiple pillars of therapy should be aggressively needed in rapidly progressive CKD. To maximize the benefit and minimize the treatment burden in each person, assessing individual eGFR slope is important. Disclosure K. Kashima: None. C. Kojima: None.

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1838-P: Individualized Slope Analysis: Optimizing Reno-Protective Pillars of Therapy

Key Points

Abstract

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