Recent studies have indicated significant advancements in the management of chronic kidney disease (CKD), particularly through the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i). A retrospective cohort study conducted at Ramathibodi Hospital in Bangkok, Thailand, analyzed the real-world effectiveness and safety of SGLT2i compared to traditional renin-angiotensin-aldosterone system (RAAS) blockade therapies, extending from 2010 to 2022 and including nearly 7,000 patients.
CKD is a major global health issue, currently affecting around 850 million people worldwide, driven by factors such as aging, obesity, and diabetes. Managing CKD focuses on delaying its progression and reducing associated mortality, yet effective treatments have historically been limited. For many years, RAAS medications like angiotensin-converting enzyme inhibitors (ACEIs) have been the cornerstone of CKD treatment. Despite their effectiveness, CKD rates continue to climb, prompting exploration of alternative therapies like SGLT2 inhibitors.
This study evaluated 6,946 adults with CKD stages 2 to 4, prescribing either SGLT2i (1,405 patients) or RAAS blockade (5,541 patients). Notably, patients receiving SGLT2i demonstrated significant reductions (41%) in composite major adverse kidney events (MAKEs), which include severe declines in kidney function and the need for dialysis. The findings reveal SGLT2i therapy may effectively mitigate CKD progression irrespective of the patient's diabetic status, showing promise even among non-diabetic individuals.
The research methodology incorporated advanced statistical techniques, such as propensity score matching, to account for confounding variables. Through the use of weighted Cox proportional hazards models, the study assessed treatment impacts on patient outcomes over time. Specifically, SGLT2i patients exhibited half the risk (52% lower) of progressing to stage 5 CKD compared to those on RAAS blockers.
A closer inspection of adverse events indicated similar rates between the two groups, though urinary tract infections were less prevalent among those receiving SGLT2i treatment. This discovery is particularly reassuring, contradicting earlier concerns about increased UTI risks associated with these drugs.
Overall, this study adds to the growing body of evidence supporting the use of SGLT2i therapy as safe and potentially more effective than conventional treatments for CKD. The outcomes align with the 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines, which now recommend SGLT2i for broader CKD patient populations.
The impact of these findings could be far-reaching, influencing clinical practice and guidelines worldwide, and offering new hope for CKD management strategies. Future research will be important to continue validating these results, ensuring patients receive the most optimal care as the field of nephrology advances.