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Influence of SGLT2i on Renal Progression in CKD Patients: A Multicenter Real-World Study in China
Wen-Cong Guo1, Li-Cong Su2, Bin Wang1
1Institute of Nephrology, Zhong Da Hospital, School of Medicine, Southeast University, Nanjing, China.
Introduction:
Although large randomized control trials have established the renal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in chronic kidney disease (CKD), real-world evidence in Chinese CKD populations remains scarce. Here we report a multicenter real-world retrospective cohort study of SGLT2i use in hospitalized CKD patients in China.
Methods:
We enrolled 155,053 adults with CKD from the China Renal Data System (CRDS) databases (January 2002-January 2023). We included patients treated with SGLT2i for at least 3 months. SGLT2i users and nonusers were matched (1:2) using propensity score matching (PSM). The main outcomes included renal, safety, and clinical outcomes. Renal outcomes included the first occurrence of CKD progression, end-stage kidney disease (ESKD), or composite outcomes. Multivariable Cox regression models and cumulative incidence were estimated post-PSM.
Results:
Overall, the core analysis included 1,477 SGLT2i users and 2,674 nonusers. The progression of CKD (HR 0.81, 95% confidence interval [CI] 0.69-0.95, p < 0.01), incidence of ESKD (HR 0.26, 95% CI 0.18-0.37, p < 0.001), and composite renal outcome (HR 0.68, 95% CI 0.59-0.77, p < 0.001) were significantly lower in the SGLT2i group compared to the non-SGLT2i group. Additionally, the SGLT2i group experienced lower rates of heart failure, stroke, transient ischemic attack, and severe hypoglycemia but a higher risk of acute pancreatitis compared to the non-SGLT2i group. Additionally, eGFR remains better preserved over 3 years in CKD patients treated with SGLT2i.
Conclusion:
These findings suggest that SGLT2i offers substantial renal and cardiovascular benefits for Chinese CKD patients.
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