Effects of RAS and SGLT2 inhibitors alone or in combination on end-stage kidney disease and/or all-cause death in patients with both diabetes and hypertension: a nationwide cohort study
Authors' conclusion
Combination therapy may provide the greatest renal and survival benefit for diabetic patients with hypertension. SGLT2 inhibitors alone significantly reduced mortality, while RAS inhibitors alone had a modest impact.
Study context
- Population
- Individuals with T2D and hypertension (2015–2017), Korean National Health Database
- Participants
- 261,783 individuals
- Exposure
- SGLT2i alone, RAS inhibitors alone or combination therapy vs no RAS or SGLT2i
- Outcome
- ESKD, all-cause mortality and their composite
- Follow-up
- 5.38 years
Methodological detailsKorean National Health Database, Cox regression
- Korean National Health Database
- Cox regression
Main finding
As reported in the abstract
Composite of:
- ESKD
- All-cause death
Hazard ratio (95% CI)
Combination therapyvs No RAS or SGLT2i
0.68(0.56–0.82)
SGLT2i alonevs No RAS or SGLT2i
0.71(0.61–0.84)
RAS inhibitors alonevs No RAS or SGLT2i
0.96(0.93–0.98)
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| All-cause mortalityCombination therapyvs No RAS or SGLT2i | 0.68 (0.56–0.83) | |
| All-cause mortalitySGLT2i alonevs No RAS or SGLT2i | 0.68 (0.57–0.81) | |
| All-cause mortalityRAS inhibitors alonevs No RAS or SGLT2i | 0.94 (0.91–0.97) | |
| ESKDCombination therapyvs No RAS or SGLT2i | 0.63 (0.37–1.07) | |
| 0.20.5125Hazard ratio (log scale) |
- All-cause mortality — Died overall
- 20,866 (7.97%)
- End-stage kidney disease (ESKD) — Developed ESKD overall
- 2,674 (1.02%)
ESKD
- SGLT2i consistently reduced ESKD and mortality; RAS inhibitors beneficial mainly in non-SGLT2i users
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Effects of RAS and SGLT2 inhibitors alone or in combination on end-stage kidney disease and/or all-cause death in patients with both diabetes and hypertension: a nationwide cohort study. Cardiovasc Diabetol. Published 14 July 2025. doi:10.
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