SGLT2 inhibitors promising in improving kidney outcomes for older patients with diabetic kidney disease: Real-World Study

The study, published in BMJ Open Diabetes Research & Care, revealed that the benefits of SGLT2 inhibitors on renal outcomes are also applicable to older patients with DKD aged≥75 years.

"In elderly patients (≥75 years) with diabetic kidney disease, SGLT2 inhibitors treatment led to a substantially slower decline in kidney function versus the traditional glucose-lowering medications," the researchers reported.

Diabetic kidney disease is a severe complication of diabetes characterized by the progressive deterioration of kidney function. It represents a significant burden for patients, leading to increased morbidity and mortality. While various treatment modalities exist, including lifestyle interventions and pharmacotherapy, it is a challenge to find effective strategies, especially for older patients.

Kaori Kitaoka, Shiga University of Medical Science, Otsu, Japan, and colleagues compared the kidney outcomes between patients with DKD aged ≥75 years initiating SGLT2 inhibitors versus other glucose-lowering drugs, additionally presenting with or without proteinuria.

For this purpose, the researchers developed propensity scores, implementing a 1:1 matching protocol using the Japan Chronic Kidney Disease Database.

The study's primary outcome included the decline rate in estimated glomerular filtration rate (eGFR), and secondary outcomes were a composite of a 40% reduction in eGFR or progression to end-stage kidney disease.

The study led to the following findings:

• At baseline, the mean age at initiation of SGLT2 inhibitors (n=348) or other glucose-lowering medications (n=348) was 77.7 years.
• The mean eGFR was 59.3 mL/min/1.73m2, and proteinuria was 33.0% of patients.
• Throughout the follow-up period, the mean annual rate of eGFR change was -0.80 mL/min/1.73 m2/year among SGLT2 inhibitors group and -1.78 mL/min/1.73 m2/year in other glucose-lowering drugs group (difference in the rate of eGFR decline between the groups was 0.99 mL/min/1.73 m2/year), favoring SGLT2 inhibitors.
• Composite renal outcomes were observed 38 in the SGLT2 inhibitors group and 57 in the other glucose-lowering medications group (HR 0.64).
• There was no evidence of an interaction between SGLT2 inhibitor initiation and proteinuria.

In conclusion, Japan Chronic Kidney Disease Database Ex findings highlight the potential of SGLT2 inhibitors in improving kidney outcomes for older patients with diabetic kidney disease in real-world clinical practice. By offering renal protection and cardiovascular benefits, these medications represent a valuable addition to the armamentarium of treatments for this challenging condition.

Reference:

Kitaoka K, Yano Y, Nagasu H, Kanegae H, Chishima N, Akiyama H, Tamura K, Kashihara N. Kidney outcomes of SGLT2 inhibitors among older patients with diabetic kidney disease in real-world clinical practice: the Japan Chronic Kidney Disease Database Ex. BMJ Open Diabetes Res Care. 2024 May 30;12(3):e004115. doi: 10.1136/bmjdrc-2024-004115. PMID: 38816204.