Early Relative eGFR Decline After SGLT2 Inhibitor Initiation in Heart Failure: Clinical Correlates and Pretreatment-Anchored 12-Month Trajectories
- 1Department of Cardiology, Aichi Medical University, Nagakute 480-1195, Aichi, Japan
- 2Department of Cardiology, Nagoya Heart Center, Nagoya 461-0045, Aichi, Japan
- 3Department of Cardiology, Toyohashi Heart Center, Toyohashi 441-8530, Aichi, Japan
Abstract
Background/Objectives: Early changes in estimated glomerular filtration rate (eGFR) after sodium–glucose cotransporter 2 (SGLT2) inhibitor initiation in heart failure (HF) are difficult to interpret in routine practice. We assessed the clinical correlates of >10% early relative eGFR decline and the subsequent trajectories relative to the pretreatment eGFR. Methods: This retrospective single-center study included 295 patients with HF who remained on SGLT2 inhibitor treatment at their first eligible creatinine assessment on days 10–45 (median 25 days [IQR 21–30]; range 10–42). Multivariable regression, mixed-effects modeling, and within-patient paired analyses were used. Results: Among the 333 initiation episodes, 33 (9.9%) were excluded after early treatment discontinuation, and five repeat episodes were removed. Early decline >10% occurred in 110/295 patients (37.3%). Age ≥ 80 years (adjusted OR 2.14, 95% CI 1.21–3.81), female sex (2.51, 1.42–4.44), higher baseline eGFR per 10 mL/min/1.73 m2 (1.43, 1.21–1.69), and loop-diuretic use (1.82, 1.03–3.23) were associated with decline; the loop-diuretic association attenuated in an expanded model. Twelve-month eGFR was available for 195/295 patients (66.1%). Among the 71 with >10% early decline and paired 12-month data, the mean eGFR increased by 4.70 mL/min/1.73 m2 from the early assessment but remained 6.99 mL/min/1.73 m2 below the pretreatment (both p < 0.001). Conclusions: In this selected cohort, a mean increase after early decline did not indicate a return to the pretreatment mean. The interpretation of an isolated early eGFR value requires clinical context and subsequent measurements.
Related
- Incidence and predictors of urinary tract infections after sodium-glucose cotransporter 2 inhibitor initiation in older adults hospitalized for heart failure
- Longitudinal trajectories of questionnaire-derived health burden and clinical correlates among community-dwelling older adults: a retrospective cohort study in Deyang, China
- Comparative Strain Trajectories After Septal Myectomy, Alcohol Septal Ablation, and Myosin Inhibitor Therapy.
- Associations of mortality and sepsis after GLP-1 receptor agonist initiation versus SGLT2 inhibitor or metformin initiation in people with HIV, overweight or obesity, and type 2 diabetes: A target trial emulation
- Relative muscle mass and grip strength as complementary correlates of metabolic syndrome: a nationwide DXA-based study of Korean adults.
BibTeX
@article{suzuki2026early,
title = {{Early Relative eGFR Decline After SGLT2 Inhibitor Initiation in Heart Failure: Clinical Correlates and Pretreatment-Anchored 12-Month Trajectories}},
author = {Yoriyasu Suzuki and Tomohiro Onishi and Yusuke Nakano and Masahiro Shimoda and Reiji Goto and Takahiko Suzuki and Tetsuya Amano},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208158},
url = {https://www.mdpi.com/2077-0383/15/20/8158},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Early Relative eGFR Decline After SGLT2 Inhibitor Initiation in Heart Failure: Clinical Correlates and Pretreatment-Anchored 12-Month Trajectories
AU - Yoriyasu Suzuki
AU - Tomohiro Onishi
AU - Yusuke Nakano
AU - Masahiro Shimoda
AU - Reiji Goto
AU - Takahiko Suzuki
AU - Tetsuya Amano
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208158
UR - https://www.mdpi.com/2077-0383/15/20/8158
AB - Background/Objectives: Early changes in estimated glomerular filtration rate (eGFR) after sodium–glucose cotransporter 2 (SGLT2) inhibitor initiation in heart failure (HF) are difficult to interpret in routine practice. We assessed the clinical correlates of >10% early relative eGFR decline and the subsequent trajectories relative to the pretreatment eGFR. Methods: This retrospective single-center study included 295 patients with HF who remained on SGLT2 inhibitor treatment at their first eligible creatinine assessment on days 10–45 (median 25 days [IQR 21–30]; range 10–42). Multivariable regression, mixed-effects modeling, and within-patient paired analyses were used. Results: Among the 333 initiation episodes, 33 (9.9%) were excluded after early treatment discontinuation, and five repeat episodes were removed. Early decline >10% occurred in 110/295 patients (37.3%). Age ≥ 80 years (adjusted OR 2.14, 95% CI 1.21–3.81), female sex (2.51, 1.42–4.44), higher baseline eGFR per 10 mL/min/1.73 m2 (1.43, 1.21–1.69), and loop-diuretic use (1.82, 1.03–3.23) were associated with decline; the loop-diuretic association attenuated in an expanded model. Twelve-month eGFR was available for 195/295 patients (66.1%). Among the 71 with >10% early decline and paired 12-month data, the mean eGFR increased by 4.70 mL/min/1.73 m2 from the early assessment but remained 6.99 mL/min/1.73 m2 below the pretreatment (both p < 0.001). Conclusions: In this selected cohort, a mean increase after early decline did not indicate a return to the pretreatment mean. The interpretation of an isolated early eGFR value requires clinical context and subsequent measurements.
SN - 2077-0383
ER -