SGLT2 inhibitors and the risk of incident chronic kidney disease in type 2 diabetes

Objective: To compare the risk of incident chronic kidney disease (CKD), cardiovascular events, and mortality between users of sodium–glucose cotransporter 2 (SGLT2) inhibitors and non-users in patients with type 2 diabetes (T2D) without preexisting CKD. Methods: By Taiwan's National Health Insurance Research Database (2016–2021), 1:1 propensity score matching, 11,617 pairs of SGLT2 inhibitor users and non-users with T2D and no baseline CKD were analyzed. Cox models estimated adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for clinical outcomes. Results: SGLT2 inhibitor use was associated with lower risks of incident CKD (aHR 0.86, 95% CI 0.83–0.89), macroalbuminuria (aHR 0.85, 95% CI 0.82–0.89), acute kidney injury (aHR 0.71, 95% CI 0.59–0.86), and dialysis (aHR 0.46, 95% CI 0.20–1.06). Cardiovascular benefits included reduced risks of major adverse cardiovascular events (aHR 0.84, 95% CI 0.76–0.92), hospitalization for heart failure (aHR 0.85, 95% CI 0.76–0.96), and myocardial infarction (aHR 0.68, 95% CI 0.52–0.89). All-cause mortality was also lower among SGLT2 inhibitor users (aHR 0.73, 95% CI 0.64–0.82). Conclusions: In patients with T2D without preexisting CKD, SGLT2 inhibitor use was associated with reduced risks of kidney disease, cardiovascular events, and mortality.