Effects of SGLT2 inhibitors across the spectrum of albuminuria in cardiovascular–kidney–metabolic conditions: A pooled analysis of randomised trials
Authors' conclusion
Higher albuminuria was associated with an increased risk of cardiovascular and kidney outcomes. SGLT2i improved cardiovascular and kidney outcomes across the full range of albuminuria, including normo-albuminuria.
Study context
- Population
- Patients across the cardiovascular-kidney-metabolic spectrum in randomised clinical trials (RCTs); median baseline urinary albumin-to-creatinine ratio (UACR) 28 (8–240) mg/g
- Participants
- 26,750 patients
- Comparison
- SGLT2i vs placebo across UACR levels
- Outcome
- Kidney events, HF hospitalisations, atherothrombotic events, cardiovascular and all-cause mortality across UACR
Methodological detailspooled analysis of RCTs across the cardiovascular-kidney-metabolic (CKM) spectrum
- Pooled analysis of RCTs across the CKM spectrum
Pooled result
As reported in the abstract
- SGLT2i reduced the risk of kidney events, HF hospitalisations, atherothrombotic events, CV and all-cause mortality vs placebo across the full UACR spectrum
- SGLT2i vs Placebo: P for interaction > 0.1 for all outcomes
Further pooled results
| Outcome | gMratio (95% CI) | P value |
|---|---|---|
| Albuminuria levelsAlbuminuria reduced by 13%, on average | 0.87 (0.85–0.88) | P < 0.001 |
Baseline UACR categories
- UACR <30 mg/g
- 13 669 (51.1%)
- UACR 30-300 mg/g
- 6904 (25.8%)
- UACR >300 mg/g
- 6177 (23.1%)
Association of UACR with outcomes
- UACR was linearly associated with kidney and cardiovascular outcomes as well as mortality
Original publication
Effects of SGLT2 inhibitors across the spectrum of albuminuria in cardiovascular–kidney–metabolic conditions: A pooled analysis of randomised trials. Diabetes Obes Metab. Published 10 November 2025. doi:10.
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