Abstract
Objective: To explore the factors that contribute to the improvement in the annual change in the estimated glomerular filtration rate (eGFR slope) in patients with diabetic nephropathy at high risk of disease progression, particularly those with an eGFR of less than 30 mL/min/1.73 m(2). Methods: We analyzed 64 patients with diabetic nephropathy who underwent treatment to prevent dialysis. We compared data between the eGFR slope maintenance improvement and worsening groups and explored the factors associated with improvement in eGFR slope using multivariable analyses (UMIN000050610). Results: The mean eGFR before the interventions was 29.6 ± 11.6 mL/min/1.73 m(2), and the eGFR slope was -4.1 ± 7.7 mL/min/1.73 m(2)/year. In the univariable analyses, the eGFR slope was improved by treatment with sodium-glucose cotransporter 2 inhibitor (SGLT2i) (-5.0 ± 8.3 to -1.1 ± 4.6 mL/min/1.73 m(2)/year, P<0.01) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) (-5.5 ± 7.3 to -1.3 ± 4.5 mL/min/1.73 m(2)/year, P<0.01) before and after the interventions. In multivariate analyses, no significant association was observed between eGFR slope and BMI, blood pressure, or HbA(1c) level. However, there was a significant association between the eGFR slope and treatment with GLP-1RAs ([95% CI -10.17 to -2.70], P<0.01). Conclusions: GLP-1RAs treatment was notably associated with improvement in eGFR slope in patients with diabetic nephropathy. However, this study has several limitations, including its retrospective design, small sample size, and lack of distinction between monotherapy and combination therapy.