Can SGLT2 inhibitors prevent kidney disease in patients with Type 2 diabetes?

This study examined the effect of SGLT2 inhibitors on symptoms of kidney disease in patients with Type 2 diabetes (T2D). The authors found that these agents helped lower the chance of developing kidney disease in these patients.

In patients with diabetes, high blood glucose levels can lead to other health complications. One of these is kidney disease (KD), which can develop into kidney failure or end-stage kidney disease. Kidney failure often requires dialysis or kidney transplantation. Kidney function can be measured in different ways. The estimated glomerular filtration rate (eGFR) measures the amount of blood the kidneys filter.

Some anti-diabetes medications that help lower blood glucose levels can also improve other aspects of patients’ health.  Sodium-glucose cotransporter 2 (SGLT2) inhibitors such as empagliflozin (Jardiance) lower blood glucose by helping the kidneys filter it into the urine. It is unclear if SGLT2 inhibitors improve symptoms of KD for patients with T2D.

The results of 4 clinical trials were combined and analyzed. These trials examined the effects of SGLT2 inhibitors on symptoms of KD and kidney failure in patients with T2D. 38,723 patients with T2D received either an SGLT2 inhibitor or a placebo and were followed for 2.4 to 4.2 years.

SGLT2 inhibitors reduced the chances of patients requiring dialysis or a kidney transplant by 33%. The chances of kidney injury also decreased by 25%.

Overall, SGLT2 inhibitors lowered the likelihood of reduced kidney function, kidney failure, or mortality by 42%. The chances of reduced kidney function, kidney failure, or mortality due to KD or heart problems also decreased by 29%.

At the beginning of the study, eGFR was measured for all patients. Patients with poor eGFR (below 45 mL/min per 1.73 m²) were 30% less likely to lose kidney function or develop kidney failure after SGLT2 inhibitor treatment. Patients with good eGFR (above 90 mL/min per 1.73 m²) were 63% less likely to lose kidney function or develop kidney failure after SGLT2 inhibitor treatment.

The authors concluded that SGLT2 inhibitors reduced the chance of KD, kidney failure and mortality due to KD or heart problems in patients with T2D.

The trials used in the analysis of this study had different follow-up times and treatment doses, which may affect results. These studies also included patients with heart disease, which may have biased patient selection and therefore these results.

Talk to your doctor about ways to reduce the chance of kidney disease.