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Effects of sodium-glucose cotransporter-2 inhibitors on chronic kidney disease progression: a multi-state survival

Amarit Tansawet1, Panu Looareesuwan2, Htun Teza3

  • 1Department of Research and Medical Innovation, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.

Diabetology & Metabolic Syndrome
|November 23, 2024
PubMed
Abstract

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) significantly slowed chronic kidney disease (CKD) progression in type 2 diabetes patients. SGLT2i treatment helped patients remain in earlier CKD stages and reduced risks of advanced CKD and death.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Type 2 diabetes (T2D) management aims to prevent complications.
  • Good glycemic control is recommended for T2D patients.
  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are used in T2D therapy.

Purpose of the Study:

  • To compare chronic kidney disease (CKD) progression rates.
  • To evaluate the impact of SGLT2i on CKD progression in T2D patients.
  • To utilize a multistate model with intermediate (CKD4, CKD5) and absorbing (death) states.

Main Methods:

  • Retrieved data for T2D patients with CKD stage 3 (CKD3).
  • Matched SGLT2i users 1:2 with non-SGLT2i users by prescription date.
  • Employed Cox survival regression within a multistate model and bootstrapping for probability estimation.

Main Results:

  • Analyzed data from 6582 patients (2194 SGLT2i, 4388 non-SGLT2i).
  • At 10 years, SGLT2i group had higher likelihood of remaining in CKD3 (82.3% vs 60.4%).
  • SGLT2i group showed lower transition probabilities to CKD4 (11.3% vs 19.8%), CKD5 (2.4% vs 7.4%), and death (4.1% vs 12.4%).

Conclusions:

  • SGLT2i demonstrated a potential to delay renal function decline.
  • SGLT2i treatment appears to slow CKD progression compared to standard care.
  • This suggests SGLT2i as a beneficial therapy for T2D patients with CKD.
Keywords:
Chronic kidney diseaseDiabetesSodium-glucose cotransporter-2 inhibitors

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