Kidney Week

Abstract: SA-PO1090

Kidney Protective Effect of SGLT2 Inhibitors Based on Fractional Excretion of Total Protein

Session Information

• CKD: Epidemiology, Risk Factors, and Prevention - 3
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2301 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

• Kuno, Hideaki, The Jikei University School of Medicine, Tokyo, Japan

Hideaki Kuno

• Kanzaki, Go, The Jikei University School of Medicine, Tokyo, Japan

Go Kanzaki, MD, PhD

• Hatanaka, Saeko, The Jikei University School of Medicine, Tokyo, Japan

Saeko Hatanaka, MD

• Marumoto, Hirokazu, The Jikei University School of Medicine, Tokyo, Japan

Hirokazu Marumoto, MD

• Sasaki, Takaya, The Jikei University School of Medicine, Tokyo, Japan

Takaya Sasaki, MD

• Haruhara, Kotaro, The Jikei University School of Medicine, Tokyo, Japan

Kotaro Haruhara, MD, PhD

• Matsumoto, Kei, The Jikei University School of Medicine, Tokyo, Japan

Kei Matsumoto, MD, PhD

• Koike, Kentaro, The Jikei University School of Medicine, Tokyo, Japan

Kentaro Koike, MD, PhD

• Ueda, Hiroyuki, The Jikei University School of Medicine, Tokyo, Japan

Hiroyuki Ueda, MD, PhD

• Tsuboi, Nobuo, The Jikei University School of Medicine, Tokyo, Japan

Nobuo Tsuboi, MD, PhD, FASN

• Yokoo, Takashi, The Jikei University School of Medicine, Tokyo, Japan

Takashi Yokoo, MD, PhD

Background

An initial dipping in eGFR occurs after initiation of SGLT2 inhibitors (SGLT2i), reflecting a decrease in intraglomerular pressure. Changes in proteinuria in response to the initial dipping in eGFR are variable and the impact on renal prognosis is not clear. Fractional excretion of total protein (FETP) which was protein clearance divided by creatinine clearance is an indicator of protein leak that accounts for glomerular filtration rate. This study investigated the association between initial dipping in FETP after initiation of SGLT2i and renal prognosis in CKD.

Methods

This retrospective observational study included 112 CKD patients who received SGLT2i from 2016 to 2022 at our Hospital. The FETP was calculated as follows: FETP = (urinary total protein / serum total protein) / (urinary creatinine / serum creatinine) %. According to the decline in FETP, patients were divided into two groups. The primary outcome was eGFR slope for 2 years (Figure1).

Results

Their median age was 58.0 (interquartile range, 50.0–66.0) years, 69.6 % of which were male. eGFR was 45.0 (33.0–59.9) ml/min/1.73 m², and FETP was 0.010 (0.004-0.024) %. The eGFR slope for 2 years was significantly slower in the FETP dipper group than in the non-dipper group (Figure 2). We found that initial dipping in FETP was an independent risk factor for eGFR slope for 2 years in multivariate analysis (P=0.030).

Conclusion

We found that a greater initial dipping in FETP after initiation of SGLT2i was associated with a better renal prognosis. FETP may be a useful and convenient marker that accurately reflects changes in intraglomerular pressure after initiation of SGLT2i.

Figure 1

Figure 2