This study examined whether SGLT2 inhibitors (SGLT2i) reduce B-type natriuretic peptide (BNP) levels more than other antidiabetic drugs in 1,818 patients with diabetic kidney disease (DKD), and identified predictors of BNP reduction within 30–365 days of treatment initiation.
BNP reduction >10% occurred in 50.5% (474/939) of SGLT2i-treated patients vs. 38.6% (339/879) on other antidiabetic drugs; SGLT2i was independently associated with BNP reduction (OR 1.497, 95% CI 1.206–1.859, p<0.001). Concomitant loop diuretic use was linked to a lower rate of BNP reduction with SGLT2i.
Observational registry design limits causal inference. BNP was only measured at a single follow-up window (30–365 days), so longer-term trajectories are unknown. The 10% BNP reduction threshold is a study-defined surrogate, not a validated clinical endpoint.
In patients with DKD, initiating an SGLT2 inhibitor is associated with meaningful BNP reduction across a broad range of eGFR and proteinuria levels. Clinicians should be aware that patients already on loop diuretics may show less BNP response to SGLT2i, which may reflect more advanced cardiac disease.
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