Effect of empagliflozin on intrarenal blood flow parameters in patients with type 2 diabetes and vascular complications

Impaired intrarenal hemodynamics is one of the links in the pathogenesis of chronic kidney disease in type 2 diabetes (T2D); correction of these disorders is the target of drugs with nephroprotective activity, such as sodium-glucose cotransporter-2 (SGLT2) inhibitors. The aim of our study was to evaluate the effect of the SGLT2 inhibitor empagliflozin on intrarenal blood flow parameters in patients with T2D. Material and methods . In an open prospective cohort singlecenter study, clinical and laboratory data were monitored before the start of treatment, on the 7th, 28th, 90th, and 180th day of taking empagliflozin 10 mg/day. The study of renal blood flow parameters was carried out using Doppler ultrasonography, peak systolic (PSV), end-diastolic, and mean velocity (MV) of blood flow, as well as resistance index (RI) of intrarenal arteries were assessed. Results and discussion . Forty patients with T2D and chronic kidney disease, chronic heart failure and/or atherosclerotic cardiovascular disease were included, 17 men and 23 women, aged 43 to 76 years. In the arteries of the cortex, on the 90th day of empagliflozin administration, a decrease in PVR and MV was observed compared to the period before the start of treatment (p < 0.001 and p = 0.004, respectively). This dynamics was maintained on the 180th day (p < 0.001). The lowest values of RI in the arteries of the renal cortex were observed on the 180th day (all p < 0.01 compared to the periods before treatment, on the 7th and 28th days of empagliflozin administration). IR of blood flow in the medulla decreased from the 7th to the 90th day (p = 0.003). The revealed changes in intrarenal hemodynamics were associated with the dynamics of serum creatinine and glycated hemoglobin A1c content, as well as of albuminuria. Conclusions . In patients with T2D, a decrease in intravascular resistance and blood flow rates in the kidney is observed on the 90–180th day of empagliflozin use. Changes in intrarenal blood flow are associated with the hemodynamic and metabolic response to empagliflozin.