Induction of Severe Initial Dip in Estimated Glomerular Filtration Rate by Sodium–Glucose Cotransporter 2 Inhibitors and Baseline Hemodynamics

Sodium–glucose cotransporter 2 (SGLT2) inhibitors cause an initial dip after early administration, which can be severe in some cases. However, the relationship between SGLT2 inhibitors and severe initial dips remains unclear. This study aimed to evaluate the association between risk factors and the occurrence of severe initial dips due to SGLT2 inhibitors. This retrospective cohort study was conducted at a single center. Data were retrieved from electronic medical records. Patients who received SGLT2 inhibitors at Kido Hospital between January 2014 and December 2021 were included in the study. Of the 810 patients identified, 270 were included in this analysis. The occurrence of initial dips due to SGLT2 inhibitors was observed in 68％ of cases, 5％ of which had a severe initial dip and 63％ had a mild-to-intermediate initial dip. Moreover, a multivariate analysis revealed that SBP (hazard ratio [HR]: 0.989, 95％ confidence interval [CI]: 0.982 – 0.997, P = 0.007) and heart failure (HR: 1.756, 95％ CI: 1.045 – 2.948, P = 0.033) were independently associated with severe initial dips. This study suggests that the induction of a severe initial dip due to SGLT2 inhibitors is associated with heart failure and SBP. These factors are considerably associated with baseline hemodynamics in patients treated with SGLT2 inhibitors. Therefore, considering a severe initial dip and avoiding discontinuation of SGLT2 inhibitor treatment in patients with heart failure is necessary.