SGLT2 Inhibitors and eGFR

Summary

New research indicates that an early dip in estimated glomerular filtration rate (eGFR) after starting SGLT2 inhibitors like empagliflozin likely doesn’t hinder the drug’s kidney benefits. A meta-analysis of pooled trial data showed empagliflozin reduced the risk of creatinine increases and acute kidney injury, even in patients with an early eGFR dip. This finding suggests the initial eGFR dip is a benign effect and may not necessitate routine eGFR remeasurement after starting SGLT2 inhibitors.

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** Main Story**

So, I was just looking over some interesting research presented at the European Renal Association (ERA) meeting, and it really highlights the kidney benefits of SGLT2 inhibitors, even with that initial eGFR dip we sometimes see. You know, those things always make you a little nervous when you start a new medication, right?

This meta-analysis focused on empagliflozin (Jardiance), and it’s pretty compelling. They looked at data from over 23,000 patients – a really solid sample size! These patients had type 2 diabetes, heart failure, or chronic kidney disease (CKD). What they found was that empagliflozin actually reduces the risk of creatinine increases and acute kidney injury (AKI), even if patients experience that early dip in their estimated glomerular filtration rate (eGFR). And that’s a big deal.

Decoding the eGFR Dip

Okay, so to get into the specifics, SGLT2 inhibitors, they work by preventing the kidneys from reabsorbing glucose. This leads to more glucose being excreted in the urine. But, because of this process, it can also throw off sodium and fluid balance, which is why you sometimes see that initial dip in eGFR. Honestly, it’s a little unnerving when it happens. I’ve seen it happen, and you start to wonder if you’re doing the right thing, prescribing this drug.

That eGFR dip has definitely caused some concern, it even ended up as a potential adverse event listed for empagliflozin. However, this new research seems to suggest that the early dip is probably benign, and that it doesn’t wipe out the long-term kidney benefits of SGLT2 inhibitors. Basically, we can breathe a little easier.

What Did the Meta-Analysis Reveal?

The meta-analysis showed that empagliflozin was associated with a lower risk of a 50% or greater increase in serum creatinine within one year, which is fantastic news. They saw the hazard ratio for this creatinine increase, and it was just 0.80. Even better? Empagliflozin was also linked to a reduced risk of AKI, with a hazard ratio of 0.73! That’s significant. And the really great thing about it, is these positive outcomes were consistent across all the subgroups. Predicted acute eGFR dips or not, the drug still provides a lot of assistance.

Interestingly, the research also indicated that there was no increased risk of AKI around the time of the acute eGFR dip. This is particularly important because it directly addresses the concern that the initial eGFR drop might be harmful. Do you see where I’m going with this? It’s a real game changer for how we monitor patients.

Implications for Us

This changes how we should prescribe and monitor SGLT2 inhibitors. Because of the worry about the eGFR dip, people get nervous and sometimes stop the medication altogether. This study kind of suggests that the dip is actually a benign side effect. The result, maybe, of the drug doing its job and reducing pressure in the kidneys. It means we probably don’t need to remeasure eGFR every time we start someone on SGLT2 inhibitors, unless we’re starting a bunch of other meds at the same time, or we think they might be dehydrated. If we do this, it could encourage broader use of these helpful medications. I really think we should also take a look at the safety info on SGLT2 inhibitor labels. It could help show prescribers a more accurate picture of how the drug works.

The Road Ahead: More Research

Now, while this meta-analysis gives us some solid insights, more research is always needed, you know? For example, what are the precise physiological mechanisms behind the eGFR dip? And what are the long-term effects? It would also be really helpful to know if how big the eGFR dip is connected to future kidney results. It is important for us to understand if the same benefits apply to other SGLT2 inhibitors, too. And we should really understand SGLT2 inhibitor role, in advanced CKD, or in patients at high risk of AKI. By doing more research, we can fine-tune our clinical guidelines and make sure we’re using SGLT2 inhibitors safely and effectively for managing kidney disease. I guess the big question is, what’s next?