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Estimated Glomerular Filtration Rate Variability in Patients with Diabetes Receiving SGLT2 Inhibitors Versus DPP4
Yi-Wei Kao1,2, Tze-Fan Chao3,4, Yu-Wen Cheng5,6
1Department of Financial Technology Applications, Ming Chuan University, Taoyuan 333, Taiwan.
Pharmaceutics
|November 27, 2025
Summary
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) significantly reduced estimated glomerular filtration rate (eGFR) variability compared to dipeptidyl peptidase-4 inhibitors (DPP4i). SGLT2i therapy also lowered the risk of adverse kidney outcomes, especially in patients with high baseline eGFR variability.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Clinical trials on SGLT2 inhibitors (SGLT2i) primarily focus on eGFR slope and composite kidney outcomes.
- Limited research exists on eGFR variability as a kidney outcome and its long-term effects with SGLT2i use.
- This study investigates the impact of SGLT2i versus DPP4i on eGFR variability.
Purpose of the Study:
- To compare the effects of SGLT2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitors (DPP4i) on estimated glomerular filtration rate (eGFR) variability.
- To evaluate the association between eGFR variability and adverse kidney outcomes in patients treated with SGLT2i or DPP4i.
- To determine if SGLT2i therapy reduces kidney event risk across different levels of pre-treatment eGFR variability.
Main Methods:
- Retrospective analysis of 3777 propensity score-matched patients with type 2 diabetes.
- Patients received either SGLT2i or DPP4i between June 2016 and December 2021.
- eGFR variability assessed using coefficient of variation (COV) and standard deviation (SD) at multiple pre- and post-treatment time points.
Main Results:
- SGLT2i therapy significantly reduced eGFR variability (COV and SD), while DPP4i therapy increased COV and showed no significant change in SD.
- SGLT2i demonstrated greater reduction in eGFR variability than DPP4i, particularly in patients with high baseline variability, CKD, or rapid eGFR decline.
- High pre-treatment eGFR variability predicted adverse kidney events with DPP4i but not SGLT2i. SGLT2i consistently reduced risk across all variability levels.
Conclusions:
- SGLT2i therapy improves eGFR variability in patients with type 2 diabetes.
- SGLT2i therapy reduces the risk of major adverse kidney events (MAKEs) and abrupt kidney decline compared to DPP4i.
- The benefits of SGLT2i on kidney outcomes are particularly pronounced in patients with higher pre-treatment eGFR variability.
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