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Carnosine acts as a buffer during that decline
Note that for those of us using microdoses: there is no data on lipid effects at these lower doses, but since lipid benefits at standard doses are modest, there may be no change at lower amounts
While the nephroprotective effects of SGLT2i were initially derived from secondary endpoints of CV outcome trials (CVOTs), direct confirmation came from dedicated kidney focused trials: CREDENCE (Perkovic et al NEJM 2019| NephJC Summary), DAPA-CKD (Heerspink et al NEJM 2020| NephJC Summary) and finally EMPAKIDNEY (Herrington et al NEJM 2023| NephJC Summary)
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