# Long‐term preservation of kidney function with SGLT‐2 inhibitors versus comparator drugs in people with type 2 diabetes and chronic kidney disease

## TL;DR

SGLT2 inhibitors slow kidney function decline and improve albuminuria in type 2 diabetes patients with chronic kidney disease compared to other diabetes drugs.

## Contribution

Demonstrates SGLT2 inhibitors' superior kidney protection in real-world T2D and CKD patients compared to other glucose-lowering medications.

## Key findings

- SGLT2i users had a slower eGFR decline compared to comparator drugs (mean difference 1.43 mL/min/1.73 m2).
- SGLT2i showed greater improvement in albuminuria and lower risk of significant eGFR reduction.
- SGLT2i outperformed GLP-1RA in slowing eGFR decline in a matched subgroup analysis.

## Abstract

Chronic kidney disease (CKD) is a prevalent and serious complication of type 2 diabetes (T2D). This study aims to evaluate kidney outcomes in a real‐world cohort of patients with T2D and CKD who received SGLT2 inhibitors (SGLT2i) or other glucose‐lowering medications (GLM).

This retrospective, multicentre study analysed data from patients aged 18–80 years with T2D and CKD, who initiated an SGLT2i or other GLM between 2015 and 2020. The primary outcome was the change in estimated glomerular filtration rate (eGFR) over time. Secondary outcomes included albuminuria changes and adverse kidney events. Propensity score matching was used to balance baseline characteristics between the two groups.

After matching (n = 2020/group), patients (100% T2D with CKD) had a mean age of 63 years, BMI 32 kg/m2, HbA1c 8.2%. New‐users of SGLT2i exhibited a slower decline in eGFR compared with new users of comparators (mean difference 1.43 mL/min/1.73 m2; p = 0.048). Albuminuria improved significantly more in the SGLT2i group, with a greater likelihood of category improvement (hazard ratio [HR] 1.17; p = 0.007). SGLT2i initiation was associated with a lower incidence of kidney outcomes, including a ≥40% eGFR reduction (HR 0.63; p = 0.004). When the comparison was restricted to SGLT2i versus GLP‐1RA (n = 1266/group), the eGFR slope was significantly better with SGLT2i (mean difference 0.62 mL/min/1.73 m2/year; p = 0.046).

In this large, real‐world cohort, initiation of SGLT2i was associated with a significantly slower decline in kidney function and improved albuminuria compared with other diabetes drugs, including GLP‐1RA. These findings support SGLT2i as the most effective T2D treatment to slow CKD progression.