SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria: A Meta-Analysis
Pooling 10 large trials, SGLT2 inhibitors slowed kidney disease progression no matter how advanced the kidney disease or how little protein was in the urine, supporting their broad use.
Background
SGLT2 inhibitors reduce CKD progression in type 2 diabetes, CKD, and heart failure, but their effect in patients with stage 4 CKD or little-to-no albuminuria remained uncertain. This SMART-C analysis assessed whether eGFR or albuminuria modifies the kidney benefit.
Study design
Inverse-variance-weighted meta-analysis of 10 randomized, double-blind, placebo-controlled trials within the SMART-C consortium, each with at least 500 participants per group and at least 6 months of follow-up. The main outcome was CKD progression (kidney failure, >=50% eGFR reduction, or death from kidney failure).
Key findings
Among 70,361 participants, SGLT2 inhibitors reduced CKD progression (HR 0.62, 95% CI 0.57-0.68) consistently across eGFR strata (including <30 mL/min/1.73m2, HR 0.71) and across albuminuria categories (including <=30 mg/g, HR 0.58; P for trend not significant). Kidney failure alone was also reduced (HR 0.66).
Clinical implications
The benefit held across the full range of kidney function and albuminuria, including patients with and without diabetes analyzed separately, supporting routine use of SGLT2 inhibitors to improve kidney outcomes even in advanced CKD or minimal albuminuria.
Category
Research
Source
JAMA
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