Factors Influencing Early Kidney Function Changes After SGLT2 Inhibitor Use and Long-Term Prognosis: A Real-World Retrospective Study

Background: The renal protective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) have been confirmed. However, SGLT2i may lead to an increase in serum creatine shortly after administration. This study explores the factors influencing this change and its impact on long-term renal function. Methods: We conducted a retrospective study on patients starting SGLT2i treatment, classifying them into kidney function deterioration(RD) and no-kidney function deterioration(non-RD) groups based on serum creatinine changes within three months. Multivariate logistic regression analyzed factors influencing RD, and estimated glomerular filtration rate (eGFR) slopes were assessed with mixed-effects linear models. Results: A total of 544 patients were included, with 78(14.3%) in the RD group and 466(85.7%) in the non-RD group. Lower eGFR and serum albumin are independent risk factors for RD. With the decrease of eGFR by 10mL/min/1.73m2, the risk of RD increased by 42.3%(P<0.001). With the decrease of serum albumin by 5g/L, the risk of RD increased by 41.7%(P<0.001). The maximum difference in eGFR between the RD and non-RD groups was 13.88ml/min/1.73m2 (95%CI, 9.99 to 17.78; P<0.001) on 2months. One year after medication, the difference in eGFR was not related to whether RD occurred (P≥0.05). During the first 3months post-medication, the difference in the eGFR slope between the two groups was 40.51ml/min/1.73m2 per year (95%CI,27.43 to 53.60; P<0.001). Over three years, the difference in the eGFR slope was 0.59ml/min/1.73m2 per year (95%CI, -0.69 to 1.88; P>0.05). Conclusion: While someone experiences an increase in serum creatine, there is no significant long-term difference in renal function between the two groups.