Sodium-glucose cotransporter-2 inhibitor therapy improves renal and hepatic function in patients with cirrhosis secondary to metabolic dysfunction associated steatotic liver disease and type 2 diabetes in Frontiers in Endocrinology

2025
ASL VCO

Tipo pubblicazione

Article

Autori/Collaboratori (5)Vedi tutti...

Colletta A
Division of Internal Medicine, UMass Chan Medical School, Division of Internal Medicine, Worcester, MA, United States
Cooper KM
Division of Internal Medicine, UMass Chan Medical School, Division of Internal Medicine, Worcester, MA, United States
Placentino G
Diabetes Clinic, Azienda Sanitaria Locale Verbano Cusio Ossola (ASL VCO), Verbania, Italy

et alii...

Abstract

Purpose: Metabolic dysfunction-associated steatotic liver disease (MASLD) increases the risk of chronic kidney disease (CKD), compounding morbidity in patients with cirrhosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are disease-modifying agents in type 2 diabetes mellitus (T2DM) and CKD, but studies on their use in cirrhosis are limited. We aimed to assess the effect of SGLT2i therapy on renal and hepatic function in patients with Child-Turcotte-Pugh (CTP) B cirrhosis and T2DM. Methods: We conducted a 48-month longitudinal, retrospective cohort study of 54 patients with CTP B cirrhosis secondary to MASLD and T2DM who were initiated on SGLT2i (n=27) or insulin (n=27). Laboratory data were collected every 3 months. Liver stiffness (LS) was measured every 6 months via transient elastography (TE) and acoustic radiation force impulse with shear wave velocity (ARFI-SWV). The primary outcome was change in glomerular filtration rate (GFR) and chronic kidney disease (CKD) stage. Secondary outcomes included LS changes measured via TE and ARFI. Additional end points included MELD-Na, MELD 3.0, CTP scores, hepatic decompensations, proteinuria, body mass index (BMI), hemoglobin A1c (Hb-A1c), blood glucose (BG). Results: At baseline, the two groups were comparable in GFR (SGLT2i: 55.6 ± 1.9 vs. insulin: 58.1 ± 2.1 mL/min/1.73 m², p = 0.37), CKD stage, ARFI-SWV (2.9 ± 0.1 vs. 2.8 ± 0.1 m/s, p = 0.26), MELD-Na, and MELD 3.0. The SGLT2i group was older (p < 0.01) and had higher AST (p=0.01), ALT (p<0.01), and CTP scores (p=0.02), but lower LS by TE (p = 0.03). Over 48 months, GFR increased in the SGLT2i group (+13.5 ± 1.3) and declined in the insulin group (?4.2 ± 1.4; p < 0.01). A greater proportion of SGLT2i patients transitioned from CKD stage 3a to 2 (p = 0.04). Liver stiffness by TE decreased in the SGLT2i group (?4.0 ± 1.1 kPa), while it increased in the insulin group (+3.0 ± 2.5 kPa; p < 0.01). ARFI-SWV also declined in the SGLT2i group but incr

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DOI : 10.3389/fendo.2025.1531295

Keywords

article; body mass; Child Pugh score; chronic kidney failure; cohort analysis; decompensated liver cirrhosis; fatty liver; glomerulus filtration rate; glucose blood level; glycemic control; human; liver disease; liver function; liver stiffness; major clinical study; male; metabolic disorder; middle aged; non insulin dependent diabetes mellitus; proteinuria; retrospective study; transient elastography; hemoglobin A1c; insulin; sodium glucose cotransporter 2 inhibitor;