Introduction: Sodium-glucose co-transporter type 2 (SGLT2) inhibitors have demonstrated proven cardiovascular and renal benefits in the Caucasian population, independent of diabetes. Their use extends to cardio-nephrology. This study aims to evaluate their use in cardiology and nephrology at the Yaoundé General Hospital (YGH). Methods: This was an observational study with retrospective and prospective data collection that included adult patients on SGLT2 inhibitors for at least three months. Sociodemographic, clinical, paraclinical, therapeutic, and evolutionary variables were collected after a review of adult case files of patients who had been on SGLT2 inhibitor treatment for at least 3 months for chronic kidney or heart disease. Outcomes were left ventricular ejection fraction (LVEF), blood pressure, estimated glomerular filtration rate (eGFR), and proteinuria. Associations between variables were analyzed with a 95% confidence interval (CI) at a significance level of 5%. Results: A total of 101 patients were included (61.4% men, median age 70 years [62.5 – 78]). Side effects were: 3 cases of urinary tract infections and 1 case of amputation. Improvements in systolic (p < 0.001), diastolic (p < 0.001), and LVEF (p < 0.001) blood pressure were observed. eGFR improved with a median increase from 42 [26 – 69] mL/min/1.73m2 to 45 [24.5 – 64] mL/min/1.73m2 (p < 0.001), serum creatinine from 16.6 [11.3 – 23.8] mg/L to 15.2 [11.8 – 25.9] mg/L, and proteinuria from 0.7 [0.3 – 0.9] g/g to 0.5 [0.3 – 0.7] g/g. Men (OR = 7.5; p = 0.039) and patients receiving concomitant renin-angiotensin-aldosterone system blocker (OR = 10.2; p = 0.018) had more observed benefits. Good adherence (Morisky score = 0) was strongly associated with perceived benefits (OR = 9.26; p = 0.001). Conclusion: SGLT2 inhibitors are effective and well tolerated in the cardio-nephrological context in Yaoundé, with significant clinical benefits and few adverse effects.
References
[1]
Santulli, G., Varzideh, F., Forzano, I., Wilson, S., Salemme, L., de Donato, A., et al. (2023) Functional and Clinical Importance of SGLT2-Inhibitors in Frailty: From the Kidney to the Heart. Hypertension, 80, 1800-1809. https://doi.org/10.1161/hypertensionaha.123.20598
[2]
Packer, M., Anker, S.D., Butler, J., Filippatos, G., Pocock, S.J., Carson, P., et al. (2020) Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. The New England Journal of Medicine, 383, 1413-1424.
[3]
Heerspink, H.J.L., Stefánsson, B.V., Correa-Rotter, R., Chertow, G.M., Greene, T., Hou, F., et al. (2020) Dapagliflozin in Patients with Chronic Kidney Disease. NewEnglandJournalofMedicine, 383, 1436-1446. https://doi.org/10.1056/nejmoa2024816
[4]
Wanner, C., Inzucchi, S.E., Lachin, J.M., Fitchett, D., von Eynatten, M., Mattheus, M., et al. (2016) Empagliflozin and Progression of Kidney Disease in Type 2 Diabetes. NewEnglandJournalofMedicine, 375, 323-334. https://doi.org/10.1056/nejmoa1515920
[5]
McMurray, J.J.V., Solomon, S.D., Inzucchi, S.E., Køber, L., Kosiborod, M.N., Martinez, F.A., et al. (2019) Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. The New England Journal of Medicine, 381, 1995-2008.
[6]
Qiu, M., Ding, L., Zhang, M. and Zhou, H. (2021) Safety of Four SGLT2 Inhibitors in Three Chronic Diseases: A Meta-Analysis of Large Randomized Trials of SGLT2 Inhibitors. DiabetesandVascularDiseaseResearch, 18, 1-3. https://doi.org/10.1177/14791641211011016
[7]
Jarraya, F., Niang, A., Bagha, H., Tannor, E.K., Sumaili, E.K., Wan, D.I.M., et al. (2024) The Role of Sodium-Glucose Cotransporter-2 Inhibitors in the Treatment Paradigm of CKD in Africa: An African Association of Nephrology Panel Position Paper. KidneyInternationalReports, 9, 526-548. https://doi.org/10.1016/j.ekir.2023.12.019
[8]
Ajayi, A.A., Sofowora, G.G. and Ladipo, G.O. (2020) Explaining Heart Failure Hyper-Mortality in Sub Saharan Africa: Global Genomic and Environmental Contribution Review. JournaloftheNationalMedicalAssociation, 112, 141-157. https://doi.org/10.1016/j.jnma.2020.02.003
[9]
Bulto, L.N. and Hendriks, J.M. (2024) The Burden of Cardiovascular Disease in Africa: Prevention Challenges and Opportunities for Mitigation. EuropeanJournalofCardiovascularNursing, 23, e88-e90. https://doi.org/10.1093/eurjcn/zvad134
[10]
Tchoumi, J.C.T. and Butera, G. (2013) Profile of Cardiac Disease in Cameroon and Impact on Health Care Services. Cardiovascular Diagnosis and Therapy, 3, 236-243.
[11]
Kaze, F.F., Halle, M., Mopa, H.T., Ashuntantang, G., Fouda, H., Ngogang, J., et al. (2015) Prevalence and Risk Factors of Chronic Kidney Disease in Urban Adult Cameroonians according to Three Common Estimators of the Glomerular Filtration Rate: A Cross-Sectional Study. BMCNephrology, 16, Article No. 96. https://doi.org/10.1186/s12882-015-0102-9
[12]
Hynes, D., Arruda, J., Berbaum, M., Chukwudozie, I., Fischer, M., Fitzgibbon, M., et al. (2019) Evaluating a Patient-Centered Medical Home for Patients Receiving Dialysis for Kidney Disease. Patient-Centered Outcomes Research Institute® (PCORI). https://www.pcori.org/research-results/2013/evaluating-patient-centered-medical-home-patients-receiving-dialysis-kidney
[13]
Uitrakul, S., Aksonnam, K., Srivichai, P., Wicheannarat, S. and Incomenoy, S. (2022) The Incidence and Risk Factors of Urinary Tract Infection in Patients with Type 2 Diabetes Mellitus Using SGLT2 Inhibitors: A Real-World Observational Study. Medicines, 9, Article 59. https://doi.org/10.3390/medicines9120059
[14]
Neal, B., Perkovic, V., Mahaffey, K.W., de Zeeuw, D., Fulcher, G., Erondu, N., et al. (2017) Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. NewEnglandJournalofMedicine, 377, 644-657. https://doi.org/10.1056/nejmoa1611925
[15]
Wiviott, S.D., Raz, I., Bonaca, M.P., Mosenzon, O., Kato, E.T., Cahn, A., et al. (2019) Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. NewEnglandJournalofMedicine, 380, 347-357. https://doi.org/10.1056/nejmoa1812389
[16]
Anker, S.D., Butler, J., Filippatos, G., Ferreira, J.P., Bocchi, E., Böhm, M., et al. (2021) Empagliflozin in Heart Failure with a Preserved Ejection Fraction. The New England Journal of Medicine, 385, 1451-1461.
[17]
Patel, R. and Oroszi, T. (2024) SGLT-2 Inhibitors: The Magic Bullet for Cardio-Renal Protection in Type 2 DM. Pharmacology&Pharmacy, 15, 490-507. https://doi.org/10.4236/pp.2024.1512027
[18]
Baker, W.L., Smyth, L.R., Riche, D.M., Bourret, E.M., Chamberlin, K.W. and White, W.B. (2014) Effects of Sodium-Glucose Co-Transporter 2 Inhibitors on Blood Pressure: A Systematic Review and Meta-Analysis. JournaloftheAmericanSocietyofHypertension, 8, 262-275.e9. https://doi.org/10.1016/j.jash.2014.01.007
[19]
Wheeler, D.C., Stefánsson, B.V., Jongs, N., Chertow, G.M., Greene, T., Hou, F.F., et al. (2021) Effects of Dapagliflozin on Major Adverse Kidney and Cardiovascular Events in Patients with Diabetic and Non-Diabetic Chronic Kidney Disease: A Prespecified Analysis from the DAPA-CKD Trial. TheLancetDiabetes&Endocrinology, 9, 22-31. https://doi.org/10.1016/s2213-8587(20)30369-7
[20]
Yu, M.K., Vart, P., Jongs, N., Correa-Rotter, R., Rossing, P., McMurray, J.J.V., et al. (2024) Effects of Dapagliflozin in Chronic Kidney Disease across the Spectrum of Age and by Sex. JournalofGeneralInternalMedicine, 39, 921-930. https://doi.org/10.1007/s11606-023-08397-9
[21]
Vart, P., Vaduganathan, M., Jongs, N., Remuzzi, G., Wheeler, D.C., Hou, F.F., et al. (2022) Estimated Lifetime Benefit of Combined RAAS and SGLT2 Inhibitor Therapy in Patients with Albuminuric CKD without Diabetes. ClinicalJournaloftheAmericanSocietyofNephrology, 17, 1754-1762. https://doi.org/10.2215/cjn.08900722
