Factors influencing early renal function changes after SGLT2 inhibitors use and its long-term prognosis: a real-world retrospective study

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Background The renal protective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been confirmed. However, SGLT2i may lead to an increase in serum creatine shortly after administration. This study explores the factors influencing this change and its impact on long-term renal function.Methods We retrospectively studied patients starting SGLT2i treatment, classifying them into kidney function deterioration (RD) and non-deterioration (non-RD) groups based on three-month serum creatinine changes. Multivariate logistic regression identified factors influencing RD, and mixed-effects linear models evaluated eGFR slope changes.Results A total of 544 patients were included, with 78 (14.3%) in the RD group and 466 (85.7%) in the non-RD group. Lower eGFR and serum albumin are independent risk factors for RD. With the decrease of eGFR by 10 mL/min/1.73㎡, the risk of RD increased by 42.3% (p < .001). With the decrease of serum albumin by 5 g/L, the risk of RD increased by 41.7% (p < .001). The maximum difference in eGFR between the RD and non-RD groups was 13.88 mL/min/1.73 m2 (95%CI, 9.99 to 17.78; p < .001) on two months. One year after medication, the difference in eGFR was not related to whether RD occurred (p ≥ .05). During the first three months post-medication, the difference in the eGFR slope between the two groups was 40.51 mL/min/1.73 m2 per year (95%CI, 27.43 to 53.60; p < .001). Over three years, the difference in the eGFR slope was 0.59 mL/min/1.73 m2 per year (95%CI, −0.69 to 1.88; p > .05).Conclusions While some experiences an increase in serum creatine, there is no significant long-term difference in renal function between the two groups.

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