Chronic kidney disease (CKD) is a significant global health issue, affecting nearly 850 million people worldwide. The introduction of sodium-glucose cotransporter-2 inhibitors (SGLT2i) has marked a paradigm shift in CKD management, with large-scale randomized controlled trials (RCTs) demonstrating their ability to slow kidney function decline and reduce the risk of kidney or cardiovascular death in patients with CKD, irrespective of diabetic status.
This study aimed to investigate the comparative effectiveness and safety of SGLT2i therapy versus RAAS blockade in reducing CKD progression and death from kidney or cardiovascular causes in a real-world cohort with CKD stages 2–4, including both diabetic and non-diabetic individuals. The study utilized real-world data from patients diagnosed with CKD at Ramathibodi Hospital, Bangkok, Thailand, from January 1, 2010, to December 31, 2022.
Findings suggest that SGLT2i therapy was associated with a 41% lower risk of MAKEs during follow-up compared to RAAS blockade. This association persisted after adjusting for diabetic status and other established CKD risk factors. Furthermore, SGLT2i therapy conferred a substantial benefit, with a 48% lower risk of progression to CKD stage 5. Contrary to initial safety concerns, this study found a lower incidence of urinary tract infections (UTIs) in the SGLT2i group compared to RAAS blockade, with comparable rates of other adverse events between the two groups.
The study's real-world findings complement existing evidence from RCTs by offering additional insights into the effectiveness and safety of SGLT2i therapy in routine clinical practice. The observed benefits of SGLT2i therapy in reducing the risk of MAKEs and delaying progression to CKD stage 5, along with a favorable safety profile, support the expanded use of SGLT2i in patients with CKD stages 2–4, regardless of diabetic status. These findings align with the 2024 KDIGO guidelines recommending broader application of SGLT2i in CKD management. Future studies with longer follow-up periods and comprehensive urine data collection are needed to further validate these results and refine treatment strategies for patients with CKD.
