Sodium-glucose cotransporter 2 inhibition in primary and secondary glomerulonephritis.

The role of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the management glomerular/systemic autoimmune diseases with proteinuria in real-world clinical settings is unclear. Retrospective, observational, international cohort study. Adult patients with biopsy-proven glomerular diseases were included. The main outcome was the percentage reduction in 24-hour proteinuria from SGLT2i initiation to 3,6,9,12 months. Secondary outcomes included percentage change in estimated glomerular filtration rate(eGFR), proteinuria reduction by type of disease, and reduction of proteinuria ≥ 30% from SGLT2i initiation. Four-hundred and ninety-three patients with a median age of 55 years and background therapy with renin-angiotensin system blockers were included. Proteinuria from baseline changed by -35%, -41%, -45% and -48% at 3, 6, 9 and 12 months after SGLT2i initiation, while eGFR changed by -6%, -3%, -8%, -10.5% at 3,6,9 and 12 months, respectively. Results were similar irrespective of the underlying disease. A correlation was found between body mass index (BMI) and percentage proteinuria reduction at last follow-up. By mixed-effects logistic regression model, serum albumin at SGLT2i initiation emerged as predictor of ≥ 30% proteinuria reduction (odds ratio for albumin < 3.5 g/dl: 0.53; 95%CI 0.30-0.91; p = 0.02). A slower eGFR decline was observed in patients achieving a ≥ 30% proteinuria reduction: -3.7 versus -5.3 ml/min/1.73m2/year (p = 0.001). The overall tolerance to SGLT2i was good. The use of SGLT2i was associated with a significant reduction of proteinuria. This percentage change is greater in patients with higher BMI. Higher serum albumin at SGLT2i onset is associated with higher probability of achieving a ≥ 30% proteinuria reduction.

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© The Author(s) 2023. Published by Oxford University Press on behalf of the ERA.