Seminars in arthritis and rheumatism · 2025
Kidney outcomes of systemic lupus erythematosus patients treated with SGLT2 inhibitors: A national cohort study.
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Sagy Iftach, Shitrit ItamarBen, Abuhasira Ran, David Ran Ben, Haviv Yosef S, Tayer-Shifman Oshrat, Abu-Shakra Mahmoud, Brav Elad, Burrack Nitzan, Zeller Lior
Аннотация
OBJECTIVES: To evaluate the impact of SGLT2 inhibitors on the estimated glomerular filtration rate (eGFR) over time in patients with systemic lupus erythematosus (SLE).
METHODS: This was a retrospective real-world analysis using the Clalit Health Services SLE registry (CHS-SLE registry), a national cohort of 4354 SLE patients. We conducted a two-step propensity-score matching analysis of SLE patients who initiated SGLT2 inhibitors between 2015 and 2022. The primary outcome was the eGFR at 24 months. We also assessed the event-free probability for SGLT2 inhibitor users versus non-users regarding a rapid decline in eGFR, ≥30 % eGFR decline, new-onset end-stage kidney disease (ESKD), and a composite of these outcomes at 24 months. Additionally, we performed subgroup analyses of eGFR changes stratified by baseline patient characteristics.
RESULTS: At baseline, 260 SGLT2 inhibitor users were matched with 413 non-users. The baseline eGFR after matching was similar between the two groups (71.0 vs. 70.0 mL/min/1.73 m², p = 0.7). At 24 months, the eGFR was 71.2 mL/min/1.73 m² (95 % CI 69.1-74.9) in the SGLT2 inhibitor users and 65.4 mL/min/1.73 m² (95 % CI 62.5-68.4) in the non-user group (p < 0.001). The use of SGLT2 inhibitors was associated with a reduced risk of developing a rapid decline in eGFR (HR 0.74, 95 % CI 0.59-0.92, p = 0.01), and a reduced risk of developing the composite outcome (HR 0.72, 95 % CI 0.53-0.97, p = 0.03).
CONCLUSIONS: In SLE patients, exposure to SGLT2 inhibitors was associated with improved kidney function and a reduced risk of developing adverse kidney outcomes.
METHODS: This was a retrospective real-world analysis using the Clalit Health Services SLE registry (CHS-SLE registry), a national cohort of 4354 SLE patients. We conducted a two-step propensity-score matching analysis of SLE patients who initiated SGLT2 inhibitors between 2015 and 2022. The primary outcome was the eGFR at 24 months. We also assessed the event-free probability for SGLT2 inhibitor users versus non-users regarding a rapid decline in eGFR, ≥30 % eGFR decline, new-onset end-stage kidney disease (ESKD), and a composite of these outcomes at 24 months. Additionally, we performed subgroup analyses of eGFR changes stratified by baseline patient characteristics.
RESULTS: At baseline, 260 SGLT2 inhibitor users were matched with 413 non-users. The baseline eGFR after matching was similar between the two groups (71.0 vs. 70.0 mL/min/1.73 m², p = 0.7). At 24 months, the eGFR was 71.2 mL/min/1.73 m² (95 % CI 69.1-74.9) in the SGLT2 inhibitor users and 65.4 mL/min/1.73 m² (95 % CI 62.5-68.4) in the non-user group (p < 0.001). The use of SGLT2 inhibitors was associated with a reduced risk of developing a rapid decline in eGFR (HR 0.74, 95 % CI 0.59-0.92, p = 0.01), and a reduced risk of developing the composite outcome (HR 0.72, 95 % CI 0.53-0.97, p = 0.03).
CONCLUSIONS: In SLE patients, exposure to SGLT2 inhibitors was associated with improved kidney function and a reduced risk of developing adverse kidney outcomes.