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The following is a summary of “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,” published in the May 2025 issue of Frontiers in Endocrinology by Colletta et al. 

Metabolic dysfunction-associated steatotic liver disease (MASLD) elevates chronic kidney disease (CKD) risk and worsens outcomes in cirrhosis, while sodium-glucose cotransporter-2 inhibitors (SGLT2i) show promise in managing type 2 diabetes mellitus (T2DM) and CKD, though their effects in cirrhosis remain understudied.  

Researchers conducted a retrospective study to evaluate the impact of SGLT2i therapy on kidney and liver function in individuals with Child-Turcotte-Pugh (CTP) B cirrhosis and T2DM.  

They studied 54 patients with CTP B cirrhosis due to MASLD and T2DM, split evenly between SGLT2i (n=27) and insulin (n=27) groups. Laboratory tests were done every 3 months, and liver stiffness (LS) was measured every 6 months using transient elastography (TE) and acoustic radiation force impulse with shear wave velocity. Primary outcomes included changes in glomerular filtration rate (GFR) and CKD stage. Secondary outcomes focused on LS changes by both methods. Additional endpoints covered MELD-Na, MELD 3.0, CTP scores, hepatic decompensations, proteinuria, body mass index (BMI), hemoglobin A1c (Hb-A1c), and blood glucose (BG).  

The results showed that GFR was similar between the SGLT2i (55.6 ± 1.9 mL/min/1.73 m²) and the insulin (58.1 ± 2.1 mL/min/1.73 m², P= 0.37), along with CKD stage, acoustic radiation force impulse shear wave velocity (2.9 ± 0.1 vs. 2.8 ± 0.1 m/s, P= 0.26), Model for End-Stage Liver Disease-Sodium (MELD-Na), and MELD 3.0 scores. The SGLT2i group was older (P< 0.01) and showed higher levels of aspartate aminotransferase (AST) (P= 0.01), alanine aminotransferase (ALT) (P< 0.01), and CTP scores (p = 0.02), but exhibited lower LS by TE (P= 0.03). Over 48 months, the GFR increased by +13.5 ± 1.3 in the SGLT2i group, while it decreased by −4.2 ± 1.4 in the insulin group (P< 0.01). More patients on SGLT2i shifted from CKD stage 3a to 2 (P= 0.04). The LS measured by TE declined by −4.0 ± 1.1 kPa in the SGLT2i but rose by +3.0 ± 2.5 kPa in the insulin (P< 0.01). Acoustic radiation force impulse shear wave velocity decreased in the SGLT2i and increased in the insulin (2.5 ± 0.1 vs. 3.2 ± 0.1 m/s; P< 0.01). The SGLT2i also achieved significant improvements in MELD-Na, MELD 3.0, CTP scores, hepatic decompensation resolution, proteinuria, BMI, and Hb-A1c (all P< 0.01).  

Investigators concluded that people with CTP B cirrhosis and T2DM treated with SGLT2i showed significant improvements in kidney and liver function, as well as glycemic control over 48 months compared to those receiving insulin. 

Source: frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2025.1531295/full