Silvio Borrelli, Carlo Garofalo, Gianpaolo Reboldi, Annapaola Coppola, Paolo Chiodini, Mariadelina Simeoni, Alessio Mazzieri, Luca Della Volpe, Maurizio Gallieni, Carola Zummo, Santina Cottone, Maura Ravera, Filippo Aucella, Francesco Aucella, Giovanni Stallone, Valeria Gismondi, Federico Alberici, Marco Gregori, Giuseppe Castellano, Simone Vettoretti, Mario Cozzolino, Chiara Ruotolo, Roberto Minutolo, Luca De Nicola
{"title":"糖尿病肾病患者接受达帕格列净治疗 12 周后 24 小时血压曲线的变化：一项意大利多中心前瞻性研究。","authors":"Silvio Borrelli, Carlo Garofalo, Gianpaolo Reboldi, Annapaola Coppola, Paolo Chiodini, Mariadelina Simeoni, Alessio Mazzieri, Luca Della Volpe, Maurizio Gallieni, Carola Zummo, Santina Cottone, Maura Ravera, Filippo Aucella, Francesco Aucella, Giovanni Stallone, Valeria Gismondi, Federico Alberici, Marco Gregori, Giuseppe Castellano, Simone Vettoretti, Mario Cozzolino, Chiara Ruotolo, Roberto Minutolo, Luca De Nicola","doi":"10.1093/ckj/sfae316","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower ambulatory blood pressure (ABP) in patients with type 2 diabetes mellitus; whether the same holds true in diabetic kidney disease (DKD) is unknown. This information is critical to the knowledge of mechanisms of nephroprotection and safety of this therapy.</p><p><strong>Methods: </strong>This multicenter prospective study evaluates the changes in ABP after 12 weeks of dapagliflozin 10 mg/day in a cohort of patients with type 2 DKD and glomerular filtration rate (GFR) >25 mL/min/1.73 m<sup>2</sup>. Primary endpoint was the change of nighttime systolic blood pressure (SBP). Changes of daytime SBP, prevalence of normal dipping (day/night SBP ratio <0.9) and changes in ABP patterns, that is, sustained uncontrolled hypertension (SUCH), white coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and controlled hypertension (CH) were secondary endpoints.</p><p><strong>Results: </strong>Eighty-three of 96 patients completed the study [age 68.7 ± 8.9 years, 73.5% males, GFR 49 ± 17 mL/min/1.73 m<sup>2</sup>, median albuminuria: 0.18 (interquartile range 0.10-0.38) g/24 h]. After 12 weeks of dapagliflozin, nighttime SBP declined by -3.0 mmHg (95% confidence interval -5.2/-0.8 mmHg; <i>P</i> = .010) with an improvement of nighttime SBP goal (<110 mmHg) from 18.0% to 27.0% (<i>P</i> < .001). Similarly, the prevalence of normal dipping increased (from 31.3% to 50.6%, <i>P</i> = .005). A decrease in daytime (-2.4 mmHg; <i>P</i> = .046) and office (-7.9 mmHg; <i>P</i> = .009) SBP was also found. The decline of ambulatory and office SBP was associated with increased prevalence of CH (from 6.0% to 18.0%) and significant improvement of SUCH, WUCH and MUCH (<i>P</i> = .009). Albuminuria decreased (<i>P</i> < .001), whereas eGFR did not change (<i>P</i> = .297). Urinary tract infection (4.2%) and acute kidney injury (3.6%) were the main causes of drop-out. Only one patient showed a drop of nighttime SBP below 90 mmHg.</p><p><strong>Conclusions: </strong>Dapagliflozin is associated with improvement in circadian blood pressure rhythm with no major safety signal related to excessive blood pressure decrease.</p>","PeriodicalId":10435,"journal":{"name":"Clinical Kidney Journal","volume":"17 11","pages":"sfae316"},"PeriodicalIF":3.9000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536757/pdf/","citationCount":"0","resultStr":"{\"title\":\"Changes in 24-hour blood pressure profile after 12 weeks of dapagliflozin treatment in patients with diabetic kidney disease: an Italian multicenter prospective study.\",\"authors\":\"Silvio Borrelli, Carlo Garofalo, Gianpaolo Reboldi, Annapaola Coppola, Paolo Chiodini, Mariadelina Simeoni, Alessio Mazzieri, Luca Della Volpe, Maurizio Gallieni, Carola Zummo, Santina Cottone, Maura Ravera, Filippo Aucella, Francesco Aucella, Giovanni Stallone, Valeria Gismondi, Federico Alberici, Marco Gregori, Giuseppe Castellano, Simone Vettoretti, Mario Cozzolino, Chiara Ruotolo, Roberto Minutolo, Luca De Nicola\",\"doi\":\"10.1093/ckj/sfae316\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower ambulatory blood pressure (ABP) in patients with type 2 diabetes mellitus; whether the same holds true in diabetic kidney disease (DKD) is unknown. This information is critical to the knowledge of mechanisms of nephroprotection and safety of this therapy.</p><p><strong>Methods: </strong>This multicenter prospective study evaluates the changes in ABP after 12 weeks of dapagliflozin 10 mg/day in a cohort of patients with type 2 DKD and glomerular filtration rate (GFR) >25 mL/min/1.73 m<sup>2</sup>. Primary endpoint was the change of nighttime systolic blood pressure (SBP). Changes of daytime SBP, prevalence of normal dipping (day/night SBP ratio <0.9) and changes in ABP patterns, that is, sustained uncontrolled hypertension (SUCH), white coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and controlled hypertension (CH) were secondary endpoints.</p><p><strong>Results: </strong>Eighty-three of 96 patients completed the study [age 68.7 ± 8.9 years, 73.5% males, GFR 49 ± 17 mL/min/1.73 m<sup>2</sup>, median albuminuria: 0.18 (interquartile range 0.10-0.38) g/24 h]. After 12 weeks of dapagliflozin, nighttime SBP declined by -3.0 mmHg (95% confidence interval -5.2/-0.8 mmHg; <i>P</i> = .010) with an improvement of nighttime SBP goal (<110 mmHg) from 18.0% to 27.0% (<i>P</i> < .001). Similarly, the prevalence of normal dipping increased (from 31.3% to 50.6%, <i>P</i> = .005). A decrease in daytime (-2.4 mmHg; <i>P</i> = .046) and office (-7.9 mmHg; <i>P</i> = .009) SBP was also found. The decline of ambulatory and office SBP was associated with increased prevalence of CH (from 6.0% to 18.0%) and significant improvement of SUCH, WUCH and MUCH (<i>P</i> = .009). Albuminuria decreased (<i>P</i> < .001), whereas eGFR did not change (<i>P</i> = .297). Urinary tract infection (4.2%) and acute kidney injury (3.6%) were the main causes of drop-out. Only one patient showed a drop of nighttime SBP below 90 mmHg.</p><p><strong>Conclusions: </strong>Dapagliflozin is associated with improvement in circadian blood pressure rhythm with no major safety signal related to excessive blood pressure decrease.</p>\",\"PeriodicalId\":10435,\"journal\":{\"name\":\"Clinical Kidney Journal\",\"volume\":\"17 11\",\"pages\":\"sfae316\"},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-10-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11536757/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Kidney Journal\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ckj/sfae316\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/11/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Kidney Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ckj/sfae316","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/11/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Changes in 24-hour blood pressure profile after 12 weeks of dapagliflozin treatment in patients with diabetic kidney disease: an Italian multicenter prospective study.
Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) lower ambulatory blood pressure (ABP) in patients with type 2 diabetes mellitus; whether the same holds true in diabetic kidney disease (DKD) is unknown. This information is critical to the knowledge of mechanisms of nephroprotection and safety of this therapy.
Methods: This multicenter prospective study evaluates the changes in ABP after 12 weeks of dapagliflozin 10 mg/day in a cohort of patients with type 2 DKD and glomerular filtration rate (GFR) >25 mL/min/1.73 m2. Primary endpoint was the change of nighttime systolic blood pressure (SBP). Changes of daytime SBP, prevalence of normal dipping (day/night SBP ratio <0.9) and changes in ABP patterns, that is, sustained uncontrolled hypertension (SUCH), white coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and controlled hypertension (CH) were secondary endpoints.
Results: Eighty-three of 96 patients completed the study [age 68.7 ± 8.9 years, 73.5% males, GFR 49 ± 17 mL/min/1.73 m2, median albuminuria: 0.18 (interquartile range 0.10-0.38) g/24 h]. After 12 weeks of dapagliflozin, nighttime SBP declined by -3.0 mmHg (95% confidence interval -5.2/-0.8 mmHg; P = .010) with an improvement of nighttime SBP goal (<110 mmHg) from 18.0% to 27.0% (P < .001). Similarly, the prevalence of normal dipping increased (from 31.3% to 50.6%, P = .005). A decrease in daytime (-2.4 mmHg; P = .046) and office (-7.9 mmHg; P = .009) SBP was also found. The decline of ambulatory and office SBP was associated with increased prevalence of CH (from 6.0% to 18.0%) and significant improvement of SUCH, WUCH and MUCH (P = .009). Albuminuria decreased (P < .001), whereas eGFR did not change (P = .297). Urinary tract infection (4.2%) and acute kidney injury (3.6%) were the main causes of drop-out. Only one patient showed a drop of nighttime SBP below 90 mmHg.
Conclusions: Dapagliflozin is associated with improvement in circadian blood pressure rhythm with no major safety signal related to excessive blood pressure decrease.
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About the Journal
Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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