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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
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
- Source :
- Journal of Diabetes Investigation, Vol 12, Iss 8, Pp 1408-1416 (2021), Journal of Diabetes Investigation
- Publication Year :
- 2021
- Publisher :
- Wiley, 2021.
-
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.<br />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.
- Subjects :
- Male
Mean arterial pressure
medicine.medical_specialty
Endocrinology, Diabetes and Metabolism
Urology
Renal function
030204 cardiovascular system & hematology
Kidney Function Tests
Diseases of the endocrine glands. Clinical endocrinology
03 medical and health sciences
0302 clinical medicine
Japan
Diabetes mellitus
Chronic kidney disease
Internal Medicine
medicine
Humans
Hypoglycemic Agents
Arterial Pressure
Diabetic Nephropathies
030212 general & internal medicine
Renal Insufficiency, Chronic
Propensity Score
Sodium-Glucose Transporter 2 Inhibitors
Aged
Retrospective Studies
Models, Statistical
Sodium–glucose cotransporter 2 inhibitors
business.industry
Type 2 Diabetes Mellitus
General Medicine
Articles
Middle Aged
medicine.disease
RC648-665
Blood pressure
Treatment Outcome
Clinical Science and Care
Diabetes Mellitus, Type 2
Propensity score matching
Albuminuria
Female
Original Article
medicine.symptom
business
Kidney disease
Glomerular Filtration Rate
Subjects
Details
- Language :
- English
- ISSN :
- 20401116 and 20401124
- Volume :
- 12
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- Journal of Diabetes Investigation
- Accession number :
- edsair.doi.dedup.....292c7952d7fd112071ee693b0fc5c9ab