Short-term eGFR changes on SGLT2 inhibitor unrelated to long-term trends

The degree of the acute decline in estimated glomerular filtration rate (eGFR) following treatment with luseogliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, varies widely among patients with type 2 diabetes, a recent study has found.

Moreover, the long-term course of change in eGFR appears to be unaffected by this initial acute dip, suggesting a protective effect on renal function.

Researchers pooled four 52-week phase III trials of luseogliflozin for type 2 diabetes. A total of 941 patients (mean age, 60.2±10.5 years) took the drug and were compared to 115 (mean age, 63.7±10.7 years) placebo recipients. Most patients saw reserved renal function, with either normal albuminuria or microalbuminuria.

Researchers grouped the participants into three, according to the degree of eGFR change after SGLT2 inhibitor treatment: acute decliners (eGFR change <–5.1; n=315), moderate decliners (eGFR change ≥–5.1; n=280), and acute elevators (eGFR change ≥0; n=346).

They found that the course of eGFR 2 weeks after luseogliflozin initiation either recovered or was maintained independently of the degree of acute change. The same was true for the rest of the year: the category of acute eGFR change after treatment had no effect on eGFR trends from weeks 12 to 52 (p=0.477).

Instead, the researchers found that a spike in urinary albumin (p=0.01) and a dip in uric acid (p<0.001) were indicative of increasing eGFR from weeks 12 to 52.

“Although the course of eGFR in the chronic phase appeared to be maintained regardless of the degree of acute changes within at least 1 year, further studies are warranted to determine the impact of acute changes in eGFR on the long-term slope of eGFR,” researchers said.