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Abstract Aim To assess if early change in albuminuria was linked to an initial change in estimated glomerular filtration rate (eGFR) and long‐term kidney outcomes in people with type 2 diabetes (T2D) receiving sodium‐glucose cotransporter‐2 (SGLT2) inhibitors. Methods Using a medical database from a multicentre healthcare institute in Taiwan, we retrospectively enrolled 8310 people receiving SGLT2 inhibitors from 1 June 2016 to 31 December 2021. We compared the risks of initial eGFR decline, major adverse renal events (MARE; >50% eGFR reduction or development of end‐stage kidney disease), major adverse cardiovascular events (MACE), or hospitalization for heart failure (HHF) using a Cox proportional hazards model. Results In all, 36.8% ( n = 3062) experienced a >30% decrease, 21.0% ( n = 1743) experienced a 0%–30% decrease, 14.4% ( n = 1199) experienced a 0%–30% increase, and 27.7% ( n = 2306) experienced a >30% increase in urine albumin‐to‐creatine ratio (UACR) after 3 months of SGLT2 inhibitor treatment. Greater acute eGFR decline at 3 months correlated with greater UACR reduction: −3.6 ± 10.9, −2.0 ± 9.5, −1.1 ± 8.6, and −0.3 ± 9.7 mL/min/1.73 m 2 for the respective UACR change groups ( p 30% UACR decline was associated with a higher risk of >30% initial eGFR decline (hazard ratio HR 2.68, 95% confidence interval CI 1.61–4.47]), a lower risk of MARE (HR 0.66, 95% CI 0.48–0.89), and a comparable risk of MACE or HHF after multivariate adjustment ( p 30%. Conclusion Physicians should be vigilant for the potential adverse effects of abrupt eGFR dipping associated with a profound reduction in UACR, despite the favourable long‐term kidney outcomes in the population with T2D receiving SGLT2 inhibitor treatment.
Kao et al. (Mon,) studied this question.