Early Introduction of SGLT-2 Inhibitors to Improve Chronic Kidney Disease Care in People with or without Diabetes—Consensus by Indian Nephrologists

Abstract Introduction: Chronic kidney disease (CKD) is a progressive condition characterized by reduced kidney function, leading to increased morbidity and mortality. The risk of cardiovascular disease is notably high among individuals with CKD and type 2 diabetes mellitus (T2D). Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have emerged as a promising treatment for CKD, offering renoprotective and cardioprotective benefits beyond glucose-lowering effects. Materials and Methods: A panel of 210 nephrologists from different regions of India participated in a consensus-building process. Using a Delphi methodology, the panelists were surveyed on various aspects of CKD care, with a focus on the use of SGLT-2 inhibitors individuals with or without diabetes. The consensus process involved multiple rounds of surveys and group discussions moderated by experts to arrive at practical recommendations for integrating SGLT-2 inhibitors into CKD management at the primary care level. Results: The majority (48.57%) of clinicians strongly agreed that primary care physicians play a vital role in early CKD management. There was a consensus on the need for early CKD screening, especially among high-risk groups, such as those with diabetes, hypertension, or a family history of kidney disease. Serum creatinine, proteinuria measurement, and estimated glomerular filtration rate were identified as the most critical diagnostic tests. The consensus supported the incorporation of SGLT-2 inhibitors into early CKD management to delay disease progression, especially in patients with T2D, with evidence suggesting significant cardiovascular and renal benefits. Conclusion: SGLT-2 inhibitors have shown substantial efficacy in improving renal and cardiovascular outcomes in CKD patients. Early integration of SGLT-2 inhibitors in CKD management, particularly in high-risk groups, can slow disease progression, reduce complications, and improve patient outcomes.