Evidence mapPaperPMID 34013739Full record

ArticleJournal of the American Heart Association2021

Clinical Implications of Estimated Glomerular Filtration Rate Dip Following Sodium-Glucose Cotransporter-2 Inhibitor Initiation on Cardiovascular and Kidney Outcomes.

Yan Xie, Benjamin Bowe, Andrew K Gibson, Janet B McGill, Geetha Maddukuri, Ziyad Al-Aly

Abstract readMulticenter Study
In one paragraph

Article in Journal of the American Heart Association, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
21citing papers in PubMed, 1 pooled it
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

21 citing papers in PubMed, 1 synthesis or guideline pooled it.

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  12. Predictors, Disparities, and Facility-Level Variation: SGLT2 Inhibitor Prescription Among US Veterans With CKD.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Yan XieClinical Epidemiology Center Research and Development Service VA Saint Louis Health Care System Saint Louis MO.
Benjamin BoweClinical Epidemiology Center Research and Development Service VA Saint Louis Health Care System Saint Louis MO.
Andrew K GibsonClinical Epidemiology Center Research and Development Service VA Saint Louis Health Care System Saint Louis MO.
Janet B McGillDepartment of Medicine Washington University School of Medicine Saint Louis MO.
Geetha MaddukuriNephrology Section Medicine Service VA Saint Louis Health Care System Saint Louis MO.
Ziyad Al-AlyClinical Epidemiology Center Research and Development Service VA Saint Louis Health Care System Saint Louis MO.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background The frequency of the initial short-term decline in estimated glomerular filtration rate (eGFR), eGFR dip, following initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i) and its clinical implications in real-world practice are not clear. Methods and Results We built a cohort of 36 638 new users of SGLT2i and 209 025 new users of other antihyperglycemics. Inverse probability weighting was used to estimate the excess rate of eGFR dip, risk of the composite cardiovascular outcome of nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, or all-cause mortality, and risk of the composite kidney outcome of eGFR decline >50%, end-stage kidney disease, or all-cause mortality. In the first 6 months of therapy, compared with other antihyperglycemics, excess rates of eGFR dip >10% and eGFR dip >30% were 9.86 (95% CI: 8.83-11.00) and 1.15 (0.70-1.62) per 100 SGLT2i users, respectively. In mediation analyses that accounted for eGFR dipping, SGLT2i use was associated with reduced risk of cardiovascular and kidney outcomes (hazard ratio, 0.92 [0.84-0.99] and 0.78 [0.71-0.87], respectively); the magnitude of the association reduced by eGFR dipping was small for both outcomes. SGLT2i was associated with reduced risk of both outcomes in those with higher than average probability of eGFR dip >10% or 30%. Compared with discontinuation, continued use of SGLT2i at 6 months was associated with reduced risk of cardiovascular and kidney outcomes in those with no eGFR dip or eGFR dip ≤10%, in those with eGFR dip >10%, and in those with eGFR dip >30%. Conclusions The salutary association of SGLT2i with cardiovascular and kidney outcomes was maintained regardless of eGFR dipping; concerns about eGFR dipping should not preclude use, and occurrence of eGFR dip after SGLT2i initiation may not warrant discontinuation.

Indexed as

AgedCardiovascular DiseasesCause of DeathDiabetes Mellitus, Type 2FemaleFollow-Up StudiesGlomerular Filtration RateHumansIncidenceKidneyKidney Failure, ChronicMaleMiddle AgedRetrospective StudiesRisk FactorsSodium-Glucose Transporter 2 InhibitorsSodium-Glucose Transporter 2 Inhibitorscardiovascular outcomesdiabetes mellitusestimated glomerular filtration ratekidneykidney functionkidney outcomessodium‐glucose cotransporter‐2 inhibitors

Identifiers

PMID34013739
PMCPMC8483543

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.