Real-World Analysis of SGLT2 Inhibitors to Prevent Cardiovascular and Kidney Outcomes in Patients with CKD: A Population-Based Cohort Study

Background: Randomized clinical trials have shown significant benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in chronic kidney disease (CKD). However, there is little data of real-world effects in this population. The objective of this study was to evaluate the effect in preventing clinical outcomes of SGLT2i in CKD patients, in a real-world population-based cohort. Methods: Observational cohort study of patients > 18 years with CKD (eGFR 20-45 mL/min/1.7m2 or eGFR 45-90 mL/min/1.7m2 with uACR > 200 mg/g) with RAAS blockage, between January 2021 and April 2024. We included patients with and without type 2 diabetes. We performed propensity score matching at a 1:2 ratio. Clinical outcomes were progression of CKD or death from CV causes, reduction of eGFR, development of ESRD, and death from any cause. Results: We analyzed 3,036 patients, 1,012 SGLT2i users, and 2,024 non-SGLT2 users. Age: 64.5 ± 11.7 years. Female: 1,254 (41.3%). Diabetes: 1,621 (53.3%). eGFR > 45 mL/min/1.7m2: 1,134 (37.3%). eGFR 30-45 mL/min/1.7m2: 1,621 (53.3%). eGFR < 30 mL/min/1.7m2: 281 (9,2%). No baseline differences were present after propensity score matching. Median follow-up: 2.8 years. Patients with SGLT2i had a lower reduction of eGFR than those without SGLT2i (-2.90 ± 0.32 vs. -4.75 ± 0.21 mL/min/1.7m2 per year; p<0.001. Figure 1). Patients with SGLT2i had a lower rate of progression of CKD or death from CV causes (13.9% vs. 19.2%, p<0.001). Multivariate analysis indicated that SGLT2i use was independently associated with reduced adverse clinical outcomes (hazard ratio: 0.71 [0.56-0.88], p<0.001). Conclusion: Our results indicate that SGLT2 inhibitors have renal and cardiovascular protective effects in real-world conditions. These results support the implementation of current guidelines in clinical practice to improve clinical outcomes in CKD patients. Study supported by FONDECYT Regular 1221571. Funding: Government Support – Non-U.S.