Abstract
Introduction: Randomized clinical trials have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce renal events in patients with type 2 diabetes mellitus (T2DM) at high risk for cardiovascular disease. However, these trials included only a small number of patients with moderate-to-severe chronic kidney disease (CKD), leaving the renoprotective effects of SGLT2 inhibitors in T2DM patients and impaired renal function unclear.
Methods: This retrospective study evaluated the effects of SGLT2 inhibitors on kidney function in T2DM patients with CKD stages 3b-4 with estimated glomerular filtration rate (eGFR) 15-45 mL/min/1.73 m². Conducted by a single nephrology group across two medical centers, the study included 175 T2DM patients who initiated SGLT2 inhibitor therapy and continued treatment for at least one year. The primary outcomes were changes in eGFR and urinary protein excretion over a one-year period.
Results: After one year of SGLT2 inhibitor therapy, the median eGFR showed no significant change from baseline. However, the annual decline in eGFR significantly improved, and urinary protein excretion decreased significantly. Despite these positive renal outcomes, HbA1c reduction was not significant.
Conclusion: This study demonstrated that SGLT2 inhibitors offer renoprotective benefits in T2DM patients with moderate-to-severe CKD by improving the annual decline in eGFR and reducing urinary protein excretion. Further prospective clinical studies are required to assess the long-term effects of SGLT2 inhibitors on glycemic control and renal function in this patient population.