Comparison of Dapagliflozin and Empagliflozin in Patients with Type 2 Diabetes and/or Chronic Kidney Disease: A Real-World Observational Study

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors provide renal protection in patients with diabetes mellitus (DM) and chronic kidney disease (CKD), but comparative real-world data on dapagliflozin and empagliflozin across different renal diagnoses are limited. Method: In this retrospective observational study, 328 adults with DM and/or CKD, including diabetic nephropathy, glomerulonephritis, and heart failure, who received dapagliflozin or empagliflozin for at least 12 months were evaluated. Demographic, clinical, and laboratory data, including estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio, were recorded at baseline and 12 months. The primary outcome was ≥50% reduction in albuminuria, and a >50% decline in eGFR was analyzed as a safety endpoint. Results: Of 328 patients (mean age 60.4 ± 11.1 years, 43.3% female), 165 received dapagliflozin and 163 received empagliflozin. Among 298 patients with DM, 61.4% achieved ≥50% reduction in albuminuria at 12 months, while 86.7% of 30 non-diabetic patients reached this target. High response rates were observed in patients with isolated DM, DM+CKD, and non-diabetic CKD, including those with glomerulonephritis. Only one patient (with DM and CKD in the empagliflozin group) experienced a >50% decline in eGFR; no such decline occurred in other subgroups. There were no significant differences between dapagliflozin and empagliflozin in albuminuria reduction or eGFR decline across diagnostic categories. Conclusion: In this real-world cohort, dapagliflozin and empagliflozin were similarly effective in substantially reducing albuminuria and preserving eGFR in patients with DM, CKD, glomerulonephritis, and heart failure. These findings support the use of SGLT2 inhibitors as renoprotective therapy across diverse high-risk populations.