Assessment of effects of combination of SGLT2 inhibitors and renin-angiotensin-aldosterone system blockers on the renal functions of patients of diabetic kidney disease (SGRASS-DKD study)

Introduction:With the advent of the novel class of drug, SGLT-2-I, there are many speculations about the combined use of this class of drug with renin-angiotensin-aldosterone system inhibitors (RAAS-I) and their effects on DKD. In spite of the fact, that there is a huge prevalence of DM in India, there is hardly any Indian study regarding their combined use. Therefore, with this in mind, the present study has been conceived and conducted in the southern part of West Bengal, India. Materials and Methods:A total of 279 patients of DKD were recruited from different private clinics in this region over a period of 12 weeks and followed up for about a year. All the patients were initiated on RAAS-I (ACE-I, ARB, or ARNI) and SGLT-2-I was added on second visit. Statistical analysis was done after the completion of the study and significance was tested using Student t test with P value of <0.05. Results:The study showed a slight male preponderance and a significant decrease in FBG, PPBG, HbA1C, and ACR and an increase in serum sodium with no significant change of serum urea, creatinine, and eGFR. A slight but clinically insignificant increase in serum potassium was also noted. Conclusion:Combination of RAAS-I and SGLT-2-I retard the progression of DKD by their composite effects on glycemic control, albuminuria, and blood pressure in this study population. Whether combining these two classes of drugs have any synergistic effects on DKD, will have to be determined by larger studies.