Evaluating kidney and heart benefits of SGLT2 inhibitors for patients with diabetes and kidney disease

This review looked at SGLT2 inhibitor medications for people with both type 2 diabetes (T2D) and chronic kidney disease (CKD). It found that SGLT2 inhibitors reduced worsening of the kidneys for these patients.

For people with diabetes, the body cannot control the amount of glucose (sugar) in the blood without treatment. Over time, high blood sugar can damage delicate blood vessels and tissues, including the kidneys. Over 40% of patients with T2D will develop chronic kidney disease (CKD). If kidney function continues to worsen, patients may need to use a dialysis machine. Dialysis can act as an artificial kidney. However, eventually, patients on dialysis may need a kidney transplant.

Controlling blood glucose levels is an essential part of preventing CKD from worsening. There are a number of diabetes medications available to manage blood sugar. However, most medications do not directly aid kidney function.

SGLT2 inhibitors are a group of diabetes medications that act on the kidneys. The kidneys act as filters to remove wastes from the blood. During this process, they absorb glucose from the waste liquid back into the bloodstream. SGLT2 inhibitors prevent the kidneys from re-absorbing glucose, causing the sugar to pass out of the body in the urine. In addition to lowing blood glucose, these medications may also reduce the wear on the kidneys from high glucose. Common SGLT2 inhibitors include dapagliflozin (Farxiga) and empagliflozin (Jardiance). SGLT2 inhibitors are also known as gliflozins. Researchers are still investigating the benefits of these medications.

This review included 9 studies with 6521 patients with both T2D and CKD. Half of the patients received SGLT2 inhibitors, while the other half received a placebo (inactive pills).

The review examined how many patients had a serious kidney outcome. This included greatly decreased kidney function, dialysis, kidney transplant, or death due to kidney failure. SGLT2 inhibitors reduced serious kidney outcomes by 35%.

The review also looked at the estimated glomerular filtration rate (eGFR). This indicates how quickly the kidneys can filter blood. Based on eGFR measurements, SGLT2 inhibitors significantly slowed the decline in kidney function.

Three trials looked at how SGLT2 inhibitors affected heart health. They found that SGLT2 inhibitors lowered the risk of serious heart attack or stroke by 25%. The chances of being hospitalized for heart failure were also 26% lower.

Patients taking SGLT2 inhibitors had better blood glucose control, as indicated by glycated hemoglobin (HbA1c) levels. They also lost weight and had lower systolic blood pressure.

There was no increase in serious side effects such as infection.

This review found that SGLT2 inhibitors reduced the risk of serious kidney outcomes for people with T2D and CKD. It also found that SGLT2 inhibitors improved blood glucose control, body weight, blood pressure, and heart health.

The trials in this review compared SGLT2 inhibitors to placebo. This review did not investigate whether SGLT2 inhibitors improve outcomes more than other diabetes medications.