Diabetes & Metabolism Journal

Original Article

Drug/Regimen
Abrupt Decline in Estimated Glomerular Filtration Rate after Initiating Sodium-Glucose Cotransporter 2 Inhibitors Predicts Clinical Outcomes: A Systematic Review and Meta-Analysis: Min-Hsiang Chuang, Yu-Shuo Tang, Jui-Yi Chen, Heng-Chih Pan, Hung-Wei Liao, Wen-Kai Chu, Chung-Yi Cheng, Vin-Cent Wu, Michael Heung; Diabetes Metab J. 2024;48(2):242-252. Published online January 26, 2024; DOI: https://doi.org/10.4093/dmj.2023.0201

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Background
The initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) typically leads to a reversible initial dip in estimated glomerular filtration rate (eGFR). The implications of this phenomenon on clinical outcomes are not well-defined.
Methods
We searched MEDLINE, Embase, and Cochrane Library from inception to March 23, 2023 to identify randomized controlled trials and cohort studies comparing kidney and cardiovascular outcomes in patients with and without initial eGFR dip after initiating SGLT2i. Pooled estimates were calculated using random-effect meta-analysis.
Results
We included seven studies in our analysis, which revealed that an initial eGFR dip following the initiation of SGLT2i was associated with less annual eGFR decline (mean difference, 0.64; 95% confidence interval [CI], 0.437 to 0.843) regardless of baseline eGFR. The risk of major adverse kidney events was similar between the non-dipping and dipping groups but reduced in patients with a ≤10% eGFR dip (hazard ratio [HR], 0.915; 95% CI, 0.865 to 0.967). No significant differences were observed in the composite of hospitalized heart failure and cardiovascular death (HR, 0.824; 95% CI, 0.633 to 1.074), hospitalized heart failure (HR, 1.059; 95% CI, 0.574 to 1.952), or all-cause mortality (HR, 0.83; 95% CI, 0.589 to 1.170). The risk of serious adverse events (AEs), discontinuation of SGLT2i due to AEs, kidney-related AEs, and volume depletion were similar between the two groups. Patients with >10% eGFR dip had increased risk of hyperkalemia compared to the non-dipping group.
Conclusion
Initial eGFR dip after initiating SGLT2i might be associated with less annual eGFR decline. There were no significant disparities in the risks of adverse cardiovascular outcomes between the dipping and non-dipping groups.

Citations

Citations to this article as recorded by

Effect of Initial eGFR and Albuminuria Changes on Clinical Outcomes in People With Diabetes Receiving SGLT2 Inhibitors
Birdie Huang, Yi-Wei Kao, Kun-Chi Yen, Shao-Wei Chen, Tze-Fan Chao, Yi-Hsin Chan
The Journal of Clinical Endocrinology & Metabolism.2025; 110(12): e3505. CrossRef
The Future of Chronic Kidney Disease Treatment: Combination Therapy (Polypill) or Biomarker-Guided Personalized Intervention?
Sajjad Biglari, Harald Mischak, Joachim Beige, Agnieszka Latosinska, Justyna Siwy, Mirosław Banasik
Biomolecules.2025; 15(6): 809. CrossRef
Continuation Versus Discontinuation of Sodium‐Glucose Cotransporter‐2 Inhibitors and Cardiorenal Outcomes Among Patients With Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Cohort Study With a Target Trial Emulation Framework
Yaa‐Hui Dong, Chia‐Hsuin Chang, Li‐Chiu Wu, Sengwee Toh
Clinical and Translational Science.2025;[Epub] CrossRef
Association of neutrophil-to-lymphocyte ratio with the risk of kidney failure in critically ill patients with heart failure: a cohort study
Ning Li, Rui Wang, Ningpeng Liang, Huang Zhang, Yifei Dong
BMC Cardiovascular Disorders.2025;[Epub] CrossRef

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