PMID- 38273790
OWN - NLM
STAT- MEDLINE
DCOM- 20240402
LR  - 20240407
IS  - 2233-6087 (Electronic)
IS  - 2233-6079 (Print)
IS  - 2233-6079 (Linking)
VI  - 48
IP  - 2
DP  - 2024 Mar
TI  - Abrupt Decline in Estimated Glomerular Filtration Rate after Initiating 
      Sodium-Glucose Cotransporter 2 Inhibitors Predicts Clinical Outcomes: A 
      Systematic Review and Meta-Analysis.
PG  - 242-252
LID - 10.4093/dmj.2023.0201 [doi]
AB  - BACKGRUOUND: 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.
FAU - Chuang, Min-Hsiang
AU  - Chuang MH
AD  - Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
FAU - Tang, Yu-Shuo
AU  - Tang YS
AD  - Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, 
      Taipei Medical University, Taipei, Taiwan.
AD  - Taipei Medical University Research Center of Urology and Kidney, Taipei, Taiwan.
FAU - Chen, Jui-Yi
AU  - Chen JY
AD  - Division of Nephrology, Department of Internal Medicine, Chi Mei Medical Center, 
      Tainan, Taiwan.
AD  - Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, 
      Tainan, Taiwan.
FAU - Pan, Heng-Chih
AU  - Pan HC
AD  - Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung 
      Memorial Hospital, Keelung, Taiwan.
FAU - Liao, Hung-Wei
AU  - Liao HW
AD  - Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, 
      Taipei Medical University, Taipei, Taiwan.
AD  - Division of Nephrology, Department of Internal Medicine, School of Medicine, 
      College of Medicine, Taipei Medical University, Taipei, Taiwan.
FAU - Chu, Wen-Kai
AU  - Chu WK
AD  - Department of Internal Medicine, National Taiwan University Hospital, National 
      Taiwan University College of Medicine, Taipei, Taiwan.
FAU - Cheng, Chung-Yi
AU  - Cheng CY
AD  - Division of Nephrology, Department of Internal Medicine, Wan Fang Hospital, 
      Taipei Medical University, Taipei, Taiwan.
AD  - Taipei Medical University Research Center of Urology and Kidney, Taipei, Taiwan.
AD  - Division of Nephrology, Department of Internal Medicine, School of Medicine, 
      College of Medicine, Taipei Medical University, Taipei, Taiwan.
FAU - Wu, Vin-Cent
AU  - Wu VC
AD  - Division of Nephrology, Department of Internal Medicine, National Taiwan 
      University Hospital, National Taiwan University College of Medicine, Taipei, 
      Taiwan.
FAU - Heung, Michael
AU  - Heung M
AD  - Division of Nephrology, Department of Medicine, University of Michigan, Ann 
      Arbor, MI, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20240126
PL  - Korea (South)
TA  - Diabetes Metab J
JT  - Diabetes & metabolism journal
JID - 101556588
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
RN  - IY9XDZ35W2 (Glucose)
RN  - 9NEZ333N27 (Sodium)
SB  - IM
MH  - Humans
MH  - *Diabetes Mellitus, Type 2/complications
MH  - *Sodium-Glucose Transporter 2 Inhibitors/adverse effects
MH  - *Cardiovascular Diseases/etiology
MH  - Glomerular Filtration Rate
MH  - *Heart Failure
MH  - Glucose/pharmacology
MH  - Sodium/pharmacology
PMC - PMC10995480
OTO - NOTNLM
OT  - Diabetes mellitus, type 2
OT  - Glomerular filtration rate
OT  - Kidney
OT  - Sodium-glucose transporter 2 inhibitors
COIS- CONFLICTS OF INTEREST No potential conflict of interest relevant to this article 
      was reported.
EDAT- 2024/01/26 06:43
MHDA- 2024/04/02 06:45
PMCR- 2024/03/01
CRDT- 2024/01/26 03:15
PHST- 2023/06/24 00:00 [received]
PHST- 2023/09/25 00:00 [accepted]
PHST- 2024/04/02 06:45 [medline]
PHST- 2024/01/26 06:43 [pubmed]
PHST- 2024/01/26 03:15 [entrez]
PHST- 2024/03/01 00:00 [pmc-release]
AID - dmj.2023.0201 [pii]
AID - dmj-2023-0201 [pii]
AID - 10.4093/dmj.2023.0201 [doi]
PST - ppublish
SO  - Diabetes Metab J. 2024 Mar;48(2):242-252. doi: 10.4093/dmj.2023.0201. Epub 2024 
      Jan 26.