Effect of SGLT2 inhibitors on the proteinuria reduction in patients with IgA nephropathy

Yaping Dong; Sufang Shi; Lijun Liu; Xujie Zhou; Jicheng Lv; Hong Zhang

doi:10.3389/fmed.2023.1242241

Effect of SGLT2 inhibitors on the proteinuria reduction in patients with IgA nephropathy

Front Med (Lausanne). 2023 Sep 6:10:1242241. doi: 10.3389/fmed.2023.1242241. eCollection 2023.

Authors

Yaping Dong^{1

2

3}, Sufang Shi^{1

2

3}, Lijun Liu^{1

2

3}, Xujie Zhou^{1

2

3}, Jicheng Lv^{1

2

3}, Hong Zhang^{1

2

3}

Affiliations

¹ Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Beijing, China.
² Key Laboratory of Renal Disease, Ministry of Health of China, Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
³ Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

Backgroud: Recent trials suggest sodium-glucose cotransporter 2 inhibitors (SGLT2i) significantly reduced proteinuria in patients with IgA nephropathy (IgAN). While little was known its efficacy in clinical practice especially in those already received full dose reninangiotensin-aldosterone system (RAAS) inhibitors.

Methods: A cohort of 93 Chinese patients with biopsy-proven IgAN and persistent proteinuria underwent full supportive therapy, including optimal blood pressure control and full dose angiotensin-converting enzyme-inhibitor or angiotensin receptor blocker therapy. Proteinuria reduction at three and six months after initiating SGLT2i therapy was analyzed.

Results: A total of 93 patients were enrolled in this study and 62 of them completed the six-month follow-up. After SGLT2i administration, a significant reduction in proteinuria was observed, with a decrease of 22.9% (p < 0.001) at three months and 27.1% (p < 0.001) at six months. During the six-month follow-up period, a decline of 3.0 mL/min/1.73m² in estimated glomerular filtration rate (eGFR) (p = 0.012) and an increase of 0.8 g/L in albumin (p = 0.017) were observed. The anti-hypertensive effect of SGLT2i was not significant (p > 0.05). Notably, a consistent antiproteinuric effect of SGLT2i was observed across various settings, including different age groups, baseline levels of proteinuria/eGFR, use of immunosuppressive agents, and the presence of comorbid diabetes and hypertension (all p values >0.05).

Conclusion: The proteinuria was significantly reduced after SGLT2i administration in IgAN patients with full dose angiotensin-converting enzyme-inhibitor or angiotensin receptor blocker therapy. Importantly, the antiproteinuric effect of SGLT2i was observed independently of immunosuppressive agent therapy, age, baseline eGFR and proteinuria levels, as well as the history of hypertension and diabetes.

Keywords: IgA nephropathy; immunosuppressive agents; proteinuria; reninangiotensin-aldosterone system inhibitors; sodium-glucose cotransporter 2 inhibitors.