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Sodium-Glucose Cotransporter-2 Inhibitors Utilization and Outcomes in Patients with Chronic Kidney Disease at a Tertiary Centre

Vol. 18 No. 2, 2023
Original article

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Abstrak

Perencat sodium-glucose cotransporter-2 (SGLT2) merupakan sejenis agen antidiabetik yang mempunyai fungsi perlindungan kepada jantung dan buah pinggang. Selain itu, ia menghalang penyerapan sodium pada bahagian tubular dan mengurangkan tekanan intraglomerular pada buah pinggang. Kebelakangan ini, penggunaan perencat SGLT semakin meningkat tanpa mengira status kencing manis dalam kalangan pesakit buah pinggang kronik. Walau bagaimanapun, data sejagat mengenai penggunaan perencat SGLT2 masih terhad. Kami menjalankan kajian deskriptif dalam kalangan pesakit buah pinggang kronik yang menggunakan perencat SGLT2 di Klinik Nefrologi. Sebanyak 156 orang pesakit telah diberikan preskripsi perencat SGLT2 bermula tahun 2017 sehingga 2022. Daripada jumlah tersebut, 58.3% adalah lelaki dengan umur purata 61 + 13 tahun dan 86.5% mempunyai kencing manis, dengan kadar purata 'estimated glomerular filtration rate' (eGFR) 46.41 + 21.14 ml/min/1.73m2 dan proteinuria 2.22 + 2.62 g/hari. Sebanyak 85.9% daripada jumlah pesakit turut menggunakan penyekat 'renin angiotensin-system' (RAS), manakala kebanyakan pesakit yang tidak menggunakan penyekat RAS adalah pesakit buah pinggang kronik peringkat 4. Dalam kalangan pesakit bukan kencing manis, sebanyak 81% mempunyai glomerulonefritis, iaitu separuh daripadanya adalah IgA nefropati dan 42.9% pesakit menggunakan immunosupresi. Terdapat pembantutan yang signifikan pada kadar penurunan eGFR dalam tempoh 6 bulan penggunaan perencat SGLT2 iaitu daripada -3.46 + 6.56 ml/min/1.73m2 kepada -0.77 + 7.97 ml/min/1.73m2 (p=0.001). Di samping itu, pembantutan terhadap kadar penurunan eGFR yang ketara turut ditunjukkan oleh pesakit buah pinggang pada peringkat yang lebih tinggi. Walau bagaimanapun, kadar penurunan proteinuria adalah tidak ketara sepanjang tempoh 6 bulan (-0.03 + 2.31 g/hari. Setakat ini tiada laporan mengenai kesan sampingan perencat SGLT2 dikenalpasti. Kesimpulannya, perencat SGLT2 melambatkan kadar penurunan eGFR dengan pengurangan kadar proteinuria secara minimum dalam jangka masa pendek. Data mengenai keberkesanan dan keselamatan jangka masa panjang perencat SGLT2 dalam populasi tempatan memerlukan penilaian lanjut.

Kata kunci

Abstract

Sodium-glucose cotransporter-2 (SGLT2) inhibitor is an antidiabetic agent with cardiac and renal protective properties. Its renal protective property is a result of the inhibition of tubular sodium reabsorption and reduction in the intraglomerular pressure. The use of SGLT2 inhibitor in chronic kidney disease (CKD) independent of diabetic status is emerging. However, the real-world data of SGLT2 inhibitor utilisation in CKD is limited. We conducted a descriptive study of patients with CKD, who were prescribed with SGLT2 inhibitor in our Nephrology Clinic. A total of 156 patients were initiated on SGLT2 inhibitor from 2017 to 2022. Among them, 58.3% were male, with a mean age of 61 + 13 years, and 86.5% had diabetes mellitus, with estimated mean glomerular filtration rate (eGFR) of 46.41 + 21.14 ml/min/1.73m2, and proteinuria of 2.22 + 2.62 g/day. A total of 85.9% of patients were on renin-angiotensin-system (RAS) blockers, whereby those who were not prescribed with RAS were mostly CKD stage 4. Among the non-diabetic patients, 81% had glomerulonephritis, half of which was IgA nephropathy, and 42.9% were on immunosuppressants. There was a significant retardation of eGFR decline over a six-month-duration after the initiation of SGLT2 inhibitor from -3.46 + 6.56 ml/min/1.73m2 to -0.77 + 7.97 ml/min/1.73m2 (p=0.001). The retardation of eGFR decline was more pronounced in more advanced CKD stages. However, the proteinuria reduction was insignificant over a six-month-duration (-0.03 + 2.31 g/day). There were no adverse events reported. In conclusion, SGLT2 inhibitor retarded the eGFR decline with minimal proteinuria reduction in short-term. Nonetheless, long-term efficacy and safety data of SGLT2 inhibitor in local populations requires further evaluation.

 

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