Sodium-Glucose Cotransporter-2 Inhibitors and Cardiorenal Events in Nonalbuminuric Kidney Disease

Most patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) do not exhibit albuminuria. However, data are limited regarding the potential benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in this subgroup.

We conducted a population-based cohort study between May 1, 2016, and December 31, 2021 using Taiwan's National Health Insurance (NHI) Research Database to examine the association between SGLT2is use and outcome in patients with T2D and nonalbuminuric CKD. Cox proportional hazard models were used to determine the risk of outcomes between the study and control groups.

The study follow-up time was 3 years. In the prematched intention-to-treat (ITT) model, SGLT2is use was associated with lower risks of dialysis (adjusted hazard ratio [aHR]: 0.21; 95% confidence interval [CI]: 0.10-0.44; P < 0.001), progression to macroalbuminuria (aHR: 0.86; 95% CI: 0.79-0.94; P = 0.001), major adverse cardiovascular events (MACE) (aHR: 0.85; 95% CI: 0.76-0.95; P = 0.005), acute kidney injury (AKI) (aHR: 0.68; 95% CI: 0.56-0.82; P < 0.001), and all-cause mortality (aHR: 0.63; 95% CI: 0.52-0.76; P < 0.001) compared with no SGLT2is use. After propensity score matching, multivariable analyses showed that SGLT2is use was associated with a lower risk of progression to macroalbuminuria (aHR: 0.84; 95% CI: 0.73-0.97; P = 0.015), and all-cause mortality (aHR: 0.40; 95% CI: 0.28-0.59; P < 0.001) compared with not using SGLT2is.

This nationwide cohort study showed that SGLT2is use was associated with a significantly lower risk of progression to macroalbuminuria, and all-cause mortality compared with nonuse in patients with T2D and nonalbuminuric CKD.