Sodium–glucose cotransporter 2 inhibitor‐induced reduction in the mean arterial pressure improved renal composite outcomes in type 2 diabetes mellitus patients with chronic kidney disease: A propensity score‐matched model analysis in Japan. Issue 8 (1st February 2021)

• Record Type: Journal Article
• Authors: Kobayashi, Kazuo; Toyoda, Masao; Hatori, Nobuo; Furuki, Takayuki; Sakai, Hiroyuki; Sato, Kazuyoshi; Miyakawa, Masaaki; Tamura, Kouichi; Kanamori, Akira
• Is Part Of: Journal of diabetes investigation. Volume 12:Issue 8(2021)
• Page Start: 1408
• Page End: 1416
• Publication Date: 2021-02-01
• Subjects: Blood pressure -- Chronic kidney disease -- Sodium–glucose cotransporter 2 inhibitors; Diabetes -- Periodicals; Diabetes -- Research -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1111/jdi.13491
• Languages: English
• ISSNs: 2040-1116

Abstract

Abstract: 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. Abstract : From the results of the propensity score matching method, the incidence of renal composite outcome was significantly lower in patients with changes in the mean arterial pressure ≤−4 mmHg than in those with changes in the mean arterial pressure >−4 mmHg ( n = 10 [5.8%] and n = 27 [15.6%], respectively, P = 0.003). The reduction in mean arterial pressure after sodium–glucose cotransporter 2 inhibitor treatment influenced the renal composite outcome in Japanese patients with type 2 diabetes mellitus and chronic kidney disease.