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Renal effects of a sodium‐glucose cotransporter 2 inhibitor, tofogliflozin, in relation to sodium intake and glycaemic status
Author(s) -
Nunoi Kiyohide,
Sato Yuichi,
Kaku Kohei,
Yoshida Akihiro,
Suganami Hideki
Publication year - 2019
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.13731
Subject(s) - medicine , renal function , basal (medicine) , body mass index , type 2 diabetes , diabetes mellitus , urology , sodium , urinary system , endocrinology , excretion , confidence interval , gastroenterology , chemistry , organic chemistry
Aims Little is known about whether sodium intake is associated with the clinical effects of SGLT2 inhibitors (SGLT2is); however, SGLT2is may increase urinary sodium excretion. Thus, we investigated the impact of daily sodium intake on the estimated glomerular filtration rate (eGFR) via an SGLT2i, tofogliflozin (TOFO), in patients with type 2 diabetes (T2D). Methods Individual‐level data on 775 T2D patients in TOFO Phase 3 trials were analysed. Adjusted changes in variables during 52 weeks of TOFO therapy were compared according to basal daily salt intake (DSI), which was measured based on estimated daily urinary sodium excretion using the Tanaka formula. Multivariable analysis was used to investigate the impact of basal DSI on changes in eGFR at Weeks 4 and 52. Results Sixty‐six percent of participants were men; mean age, HbA1c, body mass index, eGFR MDRD and median DSI were 58.5 years, 8.0%, 25.6 kg/m 2 , 83.9 mL/min/1.73 m 2 and 9.3 g/d, respectively. In all participants, eGFR MDRD sharply dipped during Week 4, and gradually increased by Week 52, showing a significant increase overall from baseline to Week 52. Multivariable analysis showed that basal DSI and HbA1c levels were independently correlated with eGFR MDRD changes at Weeks 4 and 52. Additionally, lower baseline HbA1c and DSI levels were significantly correlated with a greater increase in eGFR MDRD at Week 52. Conclusions Dietary salt intake, in addition to glycaemic control, correlates with changed eGFR MDRD via TOFO. Thus, an appropriate dietary approach to therapy should be considered before treatment of T2D patients with an SGLT2i.