Blood Pressure after Treatment with Sodium‐Glucose Cotransporter 2 Inhibitors Influences Renal Composite Outcome: Analysis using Propensity Score Matched Models

BACKGROUNDS AND OBJECTS Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve renal outcome in patients with type 2 diabetes mellitus, but the mechanism isn't fully understood. The aim of this retrospective study is to assess the association of achieved blood pressure with renal outcomes in Japanese type 2 diabetes mellitus patients with chronic kidney disease. METHODS We assessed 624 Japanese type 2 diabetes mellitus patients with chronic kidney disease on SGLT2i for >1 year. The patients were classified as those with post-treatment mean arterial pressure (MAP) of ≥92 mmHg (n=344) and those with MAP of <92 mmHg (n=280) for propensity score matching (1:1 nearest neighbor match with 0.04 of caliper value and no replacement). The endpoint was a composite of progression of albuminuria or a decrease in the estimated glomerular filtration rate by ≥15% per year. RESULTS By propensity score matching, a matched cohort model was constructed, including 201 cases in each group. The incidence of renal composite outcome was significantly lower among patients with MAP of <92 mmHg than among patients with MAP of ≥92 mmHg (n=11 [6%] vs. n=26 [13%], respectively, p=0.001). The change in estimated glomerular filtration rate was similar in the 2 groups, however the change in the albumin-to-creatinine ratio was significantly larger in patients with MAP of <92 mmHg. CONCLUSION In Japanese type 2 diabetes mellitus patients with chronic kidney disease, blood pressure after SGLT2i administration influences the renal composite outcome. Blood pressure management is important even during treatment with SGLT2i.