Effect of Initial Estimated Glomerular Filtration Rate (eGFR) and Albuminuria Changes on Clinical Outcomes in People With Diabetes Receiving SGLT2 Inhibitors
Authors' conclusion
T2D patients experiencing profound early eGFR decline without concordant UACR reduction while on SGLT2is represent a high-risk subgroup with worse clinical outcomes. These findings suggest the need for closer monitoring and potentially more aggressive therapeutic strategies for this patient population.
Study context
- Population
- T2D patients receiving SGLT2is with baseline and 3-month eGFR and urine albumin to creatinine ratio (UACR) measurements, large multicenter database in Taiwan, June 1, 2016–December 31, 2021
- Participants
- 8,222 patients
- Exposure
- >10% initial eGFR decline without UACR reduction vs modest early eGFR decline with UACR reduction, after 3 months of SGLT2i
- Outcome
- Major adverse renal events (MARE), major adverse cardiovascular events (MACE) and hospitalization for heart failure (HHF)/cardiovascular death
Methodological detailsmulticenter, real-world
- Multicenter
- Real-world
Main finding
As reported in the abstract
Each group vs modest eGFR decline with UACR reductionEstimate (95% CI)
>10% eGFR decline, no UACR reduction
aHR (MARE) 2.34(1.32–4.15)
>10% eGFR decline, no UACR reduction
aHR (MACE) 1.83(1.01–3.29)
>10% eGFR decline, no UACR reduction
aHR (HHF/cardiovascular death) 1.93(1.05–3.55)
Observational data: associations, not effects.
Further findings
Distribution of early eGFR and UACR change categories · 3 months
- No initial eGFR decline
- 40.9%
- No eGFR decline: no UACR reduction / 0%-30% / >30% reduction
- 19.8% / 8.4% / 12.7%
- >10% initial eGFR decline
- 21.5%
- >10% eGFR decline: no UACR reduction / 0%-30% / >30% reduction
- 6.5% / 4.3% / 10.7%
Original publication
Effect of Initial eGFR and Albuminuria Changes on Clinical Outcomes in People With Diabetes Receiving SGLT2 Inhibitors. J Clin Endocrinol Metab. Published 2 April 2025. doi:10.
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