Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease
Abstract Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown efficacy in clinical trials for slowing chronic kidney disease (CKD) progression, but real-world data in diverse populations are limited. This retrospective study evaluated the effectiveness and safety of SGLT2i versus renin-angi...
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Nature Portfolio
2025-01-01
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| Online Access: | https://doi.org/10.1038/s41598-025-86172-y |
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| author | Supattra Hunsuwan Sarinya Boongird Atiporn Ingsathit Wanchana Ponthongmak Nattawut Unwanatham Gareth J McKay John Attia Ammarin Thakkinstian |
| author_facet | Supattra Hunsuwan Sarinya Boongird Atiporn Ingsathit Wanchana Ponthongmak Nattawut Unwanatham Gareth J McKay John Attia Ammarin Thakkinstian |
| author_sort | Supattra Hunsuwan |
| collection | DOAJ |
| description | Abstract Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown efficacy in clinical trials for slowing chronic kidney disease (CKD) progression, but real-world data in diverse populations are limited. This retrospective study evaluated the effectiveness and safety of SGLT2i versus renin-angiotensin-aldosterone system (RAAS) blockade in CKD patients. Data from Ramathibodi Hospital (2010–2022) were analyzed, including 6,946 adults with CKD stages 2–4, with and without diabetes, who received SGLT2i (n = 1,405) or RAAS blockade (n = 5,541) for at least three months. Patients were matched 1:4 by CKD stage and treatment initiation date. A weighted Cox proportional hazards model with inverse probability weighting assessed the effect on composite major adverse kidney events (MAKEs), including eGFR decline ≥ 40%, progression to CKD stage 5, dialysis initiation, and cardiovascular or kidney death. SGLT2i therapy was associated with a lower risk of composite MAKEs (HR: 0.59; 95% CI: 0.36–0.98; P = 0.041) and less frequent progression to CKD stage 5 (HR: 0.52; 95% CI: 0.34–0.80; P < 0.003). Adverse event rates were similar between groups, with lower urinary tract infection incidence in the SGLT2i group. These findings suggest SGLT2i therapy might reduce adverse kidney outcomes in CKD patients, regardless of diabetic status, with a favorable safety profile. |
| format | Article |
| id | doaj-art-254074e682ff4063a75b227e9c063322 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Nature Portfolio |
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| series | Scientific Reports |
| spelling | doaj-art-254074e682ff4063a75b227e9c0633222025-01-12T12:24:39ZengNature PortfolioScientific Reports2045-23222025-01-0115111010.1038/s41598-025-86172-yReal-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney diseaseSupattra Hunsuwan0Sarinya Boongird1Atiporn Ingsathit2Wanchana Ponthongmak3Nattawut Unwanatham4Gareth J McKay5John Attia6Ammarin Thakkinstian7Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDivision of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDepartment of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityCentre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen’s University BelfastSchool of Medicine and Public Health, University of NewcastleDepartment of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityAbstract Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown efficacy in clinical trials for slowing chronic kidney disease (CKD) progression, but real-world data in diverse populations are limited. This retrospective study evaluated the effectiveness and safety of SGLT2i versus renin-angiotensin-aldosterone system (RAAS) blockade in CKD patients. Data from Ramathibodi Hospital (2010–2022) were analyzed, including 6,946 adults with CKD stages 2–4, with and without diabetes, who received SGLT2i (n = 1,405) or RAAS blockade (n = 5,541) for at least three months. Patients were matched 1:4 by CKD stage and treatment initiation date. A weighted Cox proportional hazards model with inverse probability weighting assessed the effect on composite major adverse kidney events (MAKEs), including eGFR decline ≥ 40%, progression to CKD stage 5, dialysis initiation, and cardiovascular or kidney death. SGLT2i therapy was associated with a lower risk of composite MAKEs (HR: 0.59; 95% CI: 0.36–0.98; P = 0.041) and less frequent progression to CKD stage 5 (HR: 0.52; 95% CI: 0.34–0.80; P < 0.003). Adverse event rates were similar between groups, with lower urinary tract infection incidence in the SGLT2i group. These findings suggest SGLT2i therapy might reduce adverse kidney outcomes in CKD patients, regardless of diabetic status, with a favorable safety profile.https://doi.org/10.1038/s41598-025-86172-yChronic kidney diseaseRAAS blockadeReal-worldSafetySGLT2 inhibitor |
| spellingShingle | Supattra Hunsuwan Sarinya Boongird Atiporn Ingsathit Wanchana Ponthongmak Nattawut Unwanatham Gareth J McKay John Attia Ammarin Thakkinstian Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease Scientific Reports Chronic kidney disease RAAS blockade Real-world Safety SGLT2 inhibitor |
| title | Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease |
| title_full | Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease |
| title_fullStr | Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease |
| title_full_unstemmed | Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease |
| title_short | Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease |
| title_sort | real world effectiveness and safety of sodium glucose co transporter 2 inhibitors in chronic kidney disease |
| topic | Chronic kidney disease RAAS blockade Real-world Safety SGLT2 inhibitor |
| url | https://doi.org/10.1038/s41598-025-86172-y |
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