Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (May 2024)

Initial eGFR Changes with SGLT2 Inhibitor in Patients With Type 2 Diabetes and Associations With the Risk of Abnormal Serum Potassium Level

  • Yi‐Wei Kao,
  • Tze‐Fan Chao,
  • Shao‐Wei Chen,
  • Yu‐Wen Cheng,
  • Yi‐Hsin Chan,
  • Pao‐Hsien Chu

DOI
https://doi.org/10.1161/JAHA.123.033236
Journal volume & issue
Vol. 13, no. 9

Abstract

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Background Both high and low levels of serum potassium measurements are linked with a higher risk of adverse clinical events among patients with type 2 diabetes. The study was aimed at evaluating the implications of the various degrees of initial estimated glomerular filtration rate (eGFR) change on subsequent serum potassium homeostasis following sodium–glucose cotransporter‐2 inhibitor (SGLT2i) initiation among patients with type 2 diabetes. Methods and Results We used medical data from a multicenter health care provider in Taiwan and recruited 5529 patients with type 2 diabetes with baseline/follow‐up eGFR data available after 4 to 12 weeks of SGLT2i treatment from June 1, 2016, to December 31, 2018. SGLT2i treatment was associated with an initial mean (SEM) eGFR decline of −3.5 (0.2) mL/min per 1.73 m2 in overall study participants. A total of 36.7% (n=2028) of patients experienced no eGFR decline, and 57.9% (n=3201) and 5.4% (n=300) of patients experienced an eGFR decline of 0% to 30% and >30%, respectively. Patients with an initial eGFR decline of >30% were associated with higher variability in consequent serum potassium measurement when compared with those without an initial eGFR decline. Participants with a pronounced eGFR decline of >30% were associated with a higher risk of hyperkalemia ≥5.5 (adjusted hazard ratio,4.59 [95% CI, 2.28–9.26]) or use of potassium binder (adjusted hazard ratio, 2.65 [95% CI, 1.78–3.95]) as well as hypokalemia events <3.0 mmol/L (adjusted hazard ratio, 3.21 [95% CI, 1.90–5.42]) or use of potassium supplement (adjusted hazard ratio, 1.87 [95% CI, 1.37–2.56]) following SGLT2i treatment after multivariate adjustment. Conclusions Physicians should be aware that the eGFR trough occurs shortly, and consequent serum potassium changes following SGLT2i initiation.

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