
doi: 10.1111/dom.16094
pmid: 39604709
Abstract Aims To investigate the effect of sodium‐glucose co‐transporter 2 inhibitor [SGLT‐2i] therapy on renal haemodynamics in T2D patients with glomerular hyperfiltration. Materials and Methods Sixty T2D patients with elevated [HYPER] and normal [NORMO] GFR were randomized to dapagliflozin 10 mg/day [DAPA/HYPER, n = 15; DAPA/NORMO, n = 15] or to metformin/glipizide [CONTROL/HYPER, n = 15; CONTROL/NORMO, n = 15] to reach similar glycaemic control after 4 months. GFR was measured with Iohexol and hyperfiltration was empirically defined as >125 mL/min/1.73 m 2 . GFR, renal plasma flow [RPF], mean arterial pressure [MAP], filtration fraction [FF], and renal vascular resistance [RVR] were determined before/after therapy. Results HbA1c decreased similarly in all 4 groups. GFR declined by ~18% in DAPA/HYPER and by ~7% in DAPA/NORMO and did not change in CONTROLS ( p < 0.05 vs. DAPA). RPF remained unchanged in all four groups. Thus, FF (%) declined from 0.23 ± 0.01 to 0.18 ± 0.01 in DAPA/HYPER and from 0.17 ± 0.01 to 0.15 ± 0.01 in DAPA/NORMO and remained unchanged in CONTROLS ( p < 0.05 vs. DAPA). MAP (mmHg) decreased from 95.4 ± 1.4 to 88.1 ± 1.3 in DAPA/HYPER and from 95.6 ± 1.3 to 91.8 ± 0.8 in DAPA/NORMO and remained unchanged in CONTROLS ( p < 0.05 vs. DAPA). RVR [mmHg/L/min] declined in DAPA/HYPER (92.7 ± 7.8 to 80.4 ± 6.1) and DAPA/NORMO (90.1 ± 3.0 to 81.4 ± 2.1) but not in CONTROLS ( p < 0.05 vs. DAPA). Conclusions Despite comparable glycaemic control, dapagliflozin treatment, but not metformin and /or glipizide, reduced glomerular hyperfiltration in T2D patients and decreased both filtration fraction and renal vascular resistance. These findings suggest that a post‐glomerular vasodilatory action of SGLT2 inhibitors contributes to their renal protective effect in T2D.
Male, Glycated Hemoglobin, Hemodynamics, Middle Aged, Kidney, Metformin, Renal Circulation, Glucosides, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Female, Diabetic Nephropathies, Vascular Resistance, Benzhydryl Compounds, Sodium-Glucose Transporter 2 Inhibitors, Glomerular Filtration Rate, Aged
Male, Glycated Hemoglobin, Hemodynamics, Middle Aged, Kidney, Metformin, Renal Circulation, Glucosides, Diabetes Mellitus, Type 2, Humans, Hypoglycemic Agents, Female, Diabetic Nephropathies, Vascular Resistance, Benzhydryl Compounds, Sodium-Glucose Transporter 2 Inhibitors, Glomerular Filtration Rate, Aged
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