A prospective study to evaluate the effects of sodium-glucose cotransporter 2 inhibitors in type 2 diabetic patients with chronic kidney disease

Abstract

Introduction: Recent studies suggest that sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective at slowing the progression of kidney disease and lowering the risk of kidney failure in people with kidney disease and type 2 diabetes. There is no such study from India. The present study was performed to evaluate the effects of SGLT2i in Indian patients with diabetes and chronic kidney disease (CKD). Materials and Methods: This prospective study included 86 patients with diabetes and chronic kidney disease and with an estimated creatinine clearance of >30 mL/minute. Forty-one patients received SGLT2i and 45 patients did not receive SGLT2i. Patients were followed up for at least 12 months. Body mass index (BMI), blood pressure, HbA1c, urine protein to creatinine ratio (UPCR), doubling of serum creatinine and rate of decline of the estimated creatinine clearance were compared between the two groups. Results: The two groups were comparable at baseline in terms of age, sex, blood pressure, BMI, HbA1c, and degree of renal impairment. Over 12 months the UPCR decreased by 0.03 in SGLT2i group and increased by 1.1 in non SGLT2i group (P < 0.05). Doubling of serum creatinine occurred in 4.8% of patients in the SGLT2i group as compared to 18% in the control group (P < 0.05). The rate of decline of the estimated creatinine clearance in the SGLT2i group was 4.9 ml/min/year as compared to 9.4 ml/min/year in the non SGLT2i group (P < 0.05). At 12 months the BMI in the SGLT2i group decreased by 1.49 as compared to 0.12 in the non SGLT2i group (P < 0.05). The blood pressure and HbA1c control were similar in both groups during the study period suggesting that the observed effect was due to SGLT2 inhibition itself and not due to blood pressure or blood glucose control. Conclusion: Our study showed that treatment with SGLT2i had significant renoprotective effects, as shown by a reduction in urinary protein excretion, less percentage of patients developing doubling of serum creatinine, and a slower rate of decline in creatinine clearance.