Discussion
DM [Hyperuricemia, renal anemia, CKD, long-term renal dysfunction, proteinuria, heart failure, renal dysfunction, albuminuria
HEART FAILURE, RENAL ANEMIA
In the present study, we found that oral administration with 10 mg DAPA daily reduced the eGFR from 1 month after starting DAPA, and the reduction sustained until second month in CKD patients without DM. Serum uric acid levels decreased, and hemoglobin levels increased by 2 month DAPA treatment. Baseline eGFR was an independent determinant of the initial eGFR dip in CKD patients without DM. We also identified that the initial eGFR dip was larger in patients currently showing exacerbation of hyperfiltration (increased eGFR and proteinuria) than those currently showing progressive renal dysfunction (decreased eGFR and increased proteinuria). Furthermore, the patients meeting exclusion criteria of DAPA-CKD trial exhibited same degree of the initial eGFR dip as others.The SGLT2i-induced initial eGFR dip has been reported by several large clinical trials, such as the EMPA-REG outcome [Large clinical trials have demonstrated the beneficial effects of SGLT2i on albuminuria in patients with DM [Hyperuricemia and renal anemia are the major therapeutic targets for CKD patients [We categorized the patients into four groups based on ∆eGFR and ∆UP before DAPA treatment and then investigated the correlation with the initial eGFR dip. The initial dip of eGFR at 1 month was larger in exacerbation of glomerular hyperfiltration group when compared to that in progressive renal dysfunction group regardless of the baseline eGFR. This finding suggests that SGLT2i is likely to ameliorate glomerular hyperfiltration in CKD patients with larger glomerular hyperfiltration, even though RAS inhibitors are already prescribed. Considering that a large decline in eGFR with DAPA at early stage is linked to prevent long-term renal dysfunction in patients with heart failure [