Key result
A mean arterial pressure reduction of ≤-4 mmHg during SGLT2 inhibitor treatment was associated with fewer composite renal outcomes than a reduction of >-4 mmHg (5.8% vs 15.6%, P=0.003).
Why the study?
Although SGLT2 inhibitors provide favorable renal outcomes in type 2 diabetes mellitus, the underlying mechanisms remain unclear, prompting investigation into how SGLT2 inhibitor-induced changes in mean arterial pressure relate to renal outcomes in patients with CKD.
Does a greater reduction in mean arterial pressure (≤-4 mmHg) during SGLT2 inhibitor treatment improve renal composite outcomes in type 2 diabetes mellitus patients with CKD?
Cohort (n=624)
Does a greater reduction in mean arterial pressure (≤-4 mmHg) during SGLT2 inhibitor treatment improve renal composite outcomes in type 2 diabetes mellitus patients with CKD?
Absolute Event Rate: 5.8% vs 15.6%
p-value: p=0.003
A greater reduction in mean arterial pressure following SGLT2 inhibitor treatment is associated with improved renal composite outcomes in patients with type 2 diabetes and CKD.
Greater MAP reduction on SGLT2i was associated with better renal outcomes in T2DM-CKD; hypothesis-generating and requires randomized confirmation.
AIMS/INTRODUCTION: Large-scale clinical trials have reported that, in patients with type 2 diabetes mellitus, sodium-glucose cotransporter 2 (SGLT2) inhibitor treatment affords favorable renal outcomes; the underlying mechanisms, however, remain unclear. Thus, this study investigated how SGLT2 inhibitor-induced changes in the mean arterial pressure (MAP; denoted as ΔMAP) are associated with renal outcomes in type 2 diabetes mellitus patients with chronic kidney disease (CKD). MATERIALS AND METHODS: We retrospectively assessed the data of 624 Japanese type 2 diabetes mellitus patients with CKD who had been using SGLT2 inhibitors for >1 year. For propensity score matching (1:1 nearest neighbor match, with caliper value = 0.053, no replacement), patients were categorized into two groups based on the ΔMAP (>-4 mmHg [n = 329] and ≤-4.0 mmHg [n = 295]). Composite albuminuria progression or a ≥15% annual reduction in the estimated glomerular filtration rate was regarded as the end-point. RESULTS: Per group, 173 propensity-matched patients were compared. Patients with ΔMAP ≤-4 mmHg had a significantly lower incidence of composite renal outcomes than those with ΔMAP ≥-4 mmHg (5.8% [n = 10] vs 15.6% [n = 27], P = 0.003). Although the between-group differences in the estimated glomerular filtration rates were non-significant, patients with a ΔMAP ≤-4 mmHg had significantly larger reductions in the logarithmic urine albumin-to-creatinine ratio (P = 0.005). CONCLUSIONS: The degree of blood pressure reduction after SGLT2 inhibitor treatment influenced renal composite outcomes in Japanese type 2 diabetes mellitus patients with CKD, confirming the importance of blood pressure management in type 2 diabetes mellitus patients with CKD, even when they are under SGLT2 inhibitor treatment.
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Kobayashi et al. (2020) conducted a cohort in Type 2 diabetes mellitus with chronic kidney disease (n=624). Mean arterial pressure reduction ≤-4 mmHg vs. Mean arterial pressure reduction >-4 mmHg was evaluated on Composite albuminuria progression or a ≥15% annual reduction in the estimated glomerular filtration rate (p=0.003). A mean arterial pressure reduction of ≤-4 mmHg during SGLT2 inhibitor treatment was associated with fewer composite renal outcomes than a reduction of >-4 mmHg (5.8% vs 15.6%, P=0.003).
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