Abstract / Summary
Abstract Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have shown potential in slowing chronic kidney disease (CKD) progression, yet their effectiveness in real-world settings warrants further validation. This retrospective cohort study utilized the Taipei Medical University Clinical Research Database (2008–2020) to assess renal outcomes among 4,202 patients with type 2 diabetes mellitus (T2DM) and CKD treated with SGLT2is (n=448), dipeptidyl peptidase-4 inhibitors (n=3,333), or thiazolidinediones (n=421). Following 1:4 propensity score matching, three renal endpoints were evaluated: sustained estimated glomerular filtration rate (eGFR) reduction ≥50%, progression to eGFR ≤15 mL/min/1.73m², and initiation of kidney replacement therapy. Cox proportional hazards models were applied to estimate risks. SGLT2i use was significantly associated with reduced risks of eGFR decline ≥50% (adjusted hazard ratio [aHR] 0.60; 95% CI: 0.40–0.90) and progression to eGFR ≤15 mL/min/1.73m² (aHR 0.53; 95% CI: 0.33–0.85) compared with other glucose-lowering agents. Subgroup analyses indicated greater benefits among patients younger than 65 years, males, those with stage 3 CKD, and concurrent statin users. SGLT2is effectively decelerate renal function decline in T2DM with CKD under routine care, underscoring their potential as early therapeutic interventions for optimal renoprotection across clinically relevant subpopulations.