Pilot study suggests association of sodium and protein intake with early GFR dip after SGLT2i initiation

Effects of dietary sodium and protein intake on early dip of glomerular filtration rate in subjects with type 2 diabetes treated with SGLT2 inhibitors

Presented at the EASD annual meeting 2022 by: Marta Seghieri, MD- Pisa, Italy

Introduction and methods

Up to ~25% of patients treated with SGLT2 inhibitors experience an acute eGFR reduction of >10% (the ‘check mark’ effect). High intake of sodium and protein may lead to an increase in intraglomerular pressure and predispose to a deeper acute eGFR reduction.

The objective of this study was to examine whether dietary sodium and protein intake can influence the extent of the early change of GFR in patients treated with SGLT2i. Furthermore, it was examined whether measured creatinine clearance (CrCl) is a sensitive enough method to detect the initial dip of GFR in these patients.

The study population consisted of 28 subjects with T2DM who initiated an SGLT2 inhibitor as add-on therapy. They were followed for 6 months. At each follow-up visit, 24 h urine sodium and urea excretion, creatinine clearance, eGFR and 24 h protein excretion were determined.

Main results

• There was a relation of baseline sodium urinary excretion and baseline urea urinary excretion with change in CrCl at month 1, 3 and 6.
• Multivariate analysis showed that change in CrCl at 1 month was associated with the interaction of baseline sodium and urea urinary excretion (beta -2.09, P=0.04)
• CrCl decreased by 19% at month 1 (eGFR by 6%) and after the initial dip, CrCl remained stable over time.

Conclusion

The results of this pilot study suggest that a higher dietary sodium and protein intake is associated with a higher extent of early dip in GFR in patients initiating SGLT2 inhibitor therapy. Furthermore, CrCl is a sensitive enough method to detect the initial dip of GFR in these patients.

Further studies are needed to confirm the results, said Marta Seghieri.

- Our reporting is based on the information provided at the EASD annual meeting -

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