Association between initial eGFR dip and renal function trajectory in patients with chronic kidney disease initiating SGLT2 inhibitors: a retrospective cohort study

Abstract Background Although sodium–glucose cotransporter 2 inhibitors (SGLT2is) induce an initial estimated glomerular filtration rate (eGFR) dip, its positive prognostic significance demonstrated in previous reports has not been fully translated into real-world practice. Misinterpretation of this dip often leads to “clinical inertia,” characterized by premature and unnecessary treatment discontinuation. Institutional evidence is required to ensure therapeutic persistence in clinical practice. Objectives To evaluate the association between the magnitude of the initial eGFR dip and the subsequent renal function trajectory in patients with CKD. Methods This single-center retrospective cohort study used electronic medical record data from CKD patients who initiated SGLT2 inhibitors between January 2017 and March 2024. Patients were classified into >10% and ≤10% initial dip groups. The primary outcome was rapid renal function decline (eGFR slope < −3.0 mL/min/1.73 m 2 /year). Propensity score matching and inverse probability of treatment weighting (IPTW) were applied. Results A total of 341 patients were included, of whom 110 (32.3%) had a > 10% initial dip. After matching, 71 pairs were analyzed. A > 10% initial dip was associated with a lower risk of rapid renal decline (odds ratio 0.40; 95% CI 0.16–0.97; p = 0.043), consistent in IPTW analyses. It was also associated with preserved renal function. Conclusions A greater initial eGFR dip was associated with a more favorable subsequent renal trajectory in CKD patients. These findings suggest that an early decline in eGFR may represent a hemodynamic response to SGLT2 inhibition, although the underlying mechanisms require further investigation.