B-type natriuretic peptide level reduction and its predictors following sodium-glucose cotransporter 2 inhibitor treatment in patients with diabetic kidney disease

Aims/Introduction Sodium-glucose cotransporter 2 (SGLT2) inhibitors can prevent cardiovascular events in patients with diabetic kidney disease. However, limited data exist regarding the change in the B-type natriuretic peptide (BNP) level after such treatment. This study investigated whether SGLT2 inhibitors are associated with a greater BNP level reduction than other antidiabetic drugs and identified the clinical predictors of BNP reduction following SGLT2 inhibitor initiation. Materials and Methods Using the nationwide Chronic Kidney Disease Database, we compared BNP levels before and 30–365 days after the initiation of antidiabetic medication in 1818 patients with diabetic kidney disease. Results Patients’ mean age was 71±12 years, and 68% were men. The mean BNP level and estimated glomerular filtration rate were 71 [27–190] pg/mL and 51±22 ml/min/1.73 m2, respectively. In total, 474 (50.5%) of 939 patients treated with SGLT2 inhibitors and 339 of 879 (38.6%) patients treated with other antidiabetic drugs experienced BNP level reduction, defined as a reduction of >10%. SGLT2 inhibitors, in comparison with other antidiabetic drugs, were associated with BNP level reduction in a multivariable logistic regression model. This association was similarly observed irrespective of the baseline estimated glomerular filtration rate, presence/absence of proteinuria, and in the analysis using the other cutoff values for BNP. The concomitant use of loop diuretics was associated with a lower rate of BNP level reduction after SGLT2 inhibitor treatment. Conclusions Compared with other antidiabetic drugs, the use of SGLT2 inhibitors was substantially associated with BNP reduction in a broad spectrum of diabetic kidney disease.graphical abstractforrest plot