3D Illustration Concept of Human Urinary System Kidneys Anatomy
The results of two groundbreaking studies have confirmed that sodium-glucose co-transporter 2 (SGLT2) inhibitors significantly reduce the risk of kidney disease progression, hospitalization, and death among individuals with varying levels of kidney function, including those without diabetes. These findings, presented at the American Society of Nephrology Kidney Week and published in JAMA, are based on data from over 70,000 participants in 10 major randomized controlled trials.
The research, conducted by the SGLT2 Inhibitor Meta-analysis Cardio-Renal Trialists’ Consortium (SMART-C) and led by The George Institute for Global Health, underscores the potential of SGLT2 inhibitors as a versatile treatment option for chronic kidney disease (CKD) and heart failure. Originally developed for type 2 diabetes, these drugs have shown promise in protecting against heart failure and CKD, yet questions remained about their efficacy in patients with advanced CKD or low albuminuria levels.
Significant Findings Across All Kidney Function Levels
In the first analysis, researchers discovered that SGLT2 inhibitors reduced the risk of CKD progression by 38% compared to a placebo. This effect was consistent across patients, irrespective of their kidney function, as measured by estimated glomerular filtration rate (eGFR). The inhibitors also slowed the annual rate of eGFR decline by 51% versus placebo, benefiting patients across all levels of kidney function and albuminuria.
Importantly, these benefits extended to individuals with stage 4 CKD (eGFR <30 mL/min/1.73m²) and those with minimal or no albuminuria—groups for whom treatment guidelines have been less clear. The data suggests that SGLT2 inhibitors could be a critical tool in managing kidney health across a broader patient demographic.
Implications for Patients with and without Diabetes
The second analysis examined the benefits and risks of SGLT2 inhibitors based on diabetes status and albuminuria levels. It found substantial benefits, particularly in reducing hospitalizations, for all patients. Heart failure hospitalizations decreased by nearly a third in patients with diabetes and a quarter in those without. The risk of serious adverse events was low, significantly outweighed by the health and mortality benefits.
“SGLT2 inhibitors are a powerful tool to reduce the burden of kidney failure, hospitalization, and premature death in patients with diabetes, CKD, or heart failure. These findings indicate that many more individuals than are currently being treated stand to benefit, highlighting a major opportunity to improve population health. Our findings support simplifying treatment guidelines to encourage broader use of these medicines.”
By: Associate Professor Brendon Neuen
Renal and Metabolic Program Lead at The George Institute
Global Health Impact and Future Prospects
Chronic kidney disease affects approximately one in ten people globally, equating to roughly 850 million individuals. It is a leading cause of death and disability, with the burden most severe in low- and middle-income countries where access to SGLT2 inhibitors remains limited.
“As these medicines become more affordable and widely available in generic form over the next few years, we have a once-in-a-generation opportunity to transform care for millions of people living with or at risk of developing kidney disease around the world.”
By: Associate Professor Brendon Neuen
The announcement comes as the medical community continues to seek effective treatments for CKD, a condition that not only impacts individual health but also places a significant burden on healthcare systems worldwide. With the potential for SGLT2 inhibitors to become more accessible, there is hope for improved outcomes for millions at risk.
SMART-C, co-chaired by Associate Professor Brendon Neuen and Professor Hiddo Heerspink, continues to lead the charge in researching these promising treatments. As the findings from these studies gain traction, the medical community anticipates a shift in treatment protocols that could redefine kidney disease management globally.
