Zenodo
SGLT2 inhibitors in chronic kidney disease with and without diabetes: Renal and cardiovascular outcomes – a literature review
By João Batista Rebouças Lima, Vanilson Pires Cerqueira Jr, Vanessa Figueredo de Brito and 2 others.
Abstract
Introduction
Chronic kidney disease (CKD) affects roughly one in ten adults and is a major driver of cardiovascular morbidity and progression to kidney failure. For decades, renin-angiotensin system blockade was the main therapy proven to slow progression, leaving a large residual risk. SGLT2 inhibitors, initially developed as glucose-lowering drugs, emerged as renoprotective agents.
Methods
Literature review of the DAPA-CKD and EMPA-KIDNEY randomized trials and the 2024 KDIGO guideline, covering efficacy, safety, and patient selection.
Results
DAPA-CKD randomized 4,304 patients with eGFR 25-75 mL/min/1.73 m² and albuminuria (UACR 200-5,000 mg/g), about two thirds with type 2 diabetes, to dapagliflozin 10 mg or placebo. Over a median of 2.4 years, dapagliflozin reduced the primary composite of sustained eGFR decline ≥50%, end-stage kidney disease, or renal or cardiovascular death (HR 0.61; 95% CI 0.51-0.72) and all-cause mortality (HR 0.69; 95% CI 0.53-0.88). EMPA-KIDNEY randomized 6,609 patients with a broader range of kidney function, including those with low albuminuria, to empagliflozin 10 mg or placebo. Over a median of 2.0 years, it reduced kidney disease progression or cardiovascular death (HR 0.72; 95% CI 0.64-0.82) and hospitalizations for any cause, with no significant effect on cardiovascular death alone.