Primary prevention of chronic kidney disease in type 2 diabetes mellitus with sodium–glucose cotransporter 2 inhibitors

PURPOSE OF REVIEW: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have emerged as a transformative class of agents that provide significant kidney and cardiovascular protection for those with diabetic kidney disease. This review summarizes more recent data on the role of SGLT2is in the primary prevention of kidney disease in persons living with diabetes. RECENT FINDINGS: Large randomized controlled trials consistently demonstrate that SGLT2i slow estimated glomerular filtration rate decline, reduce progression to end-stage kidney disease, and decrease kidney and cardiovascular mortality across a broad spectrum of participants with and without diabetes. Emerging evidence from secondary analyses of cardiovascular outcome trials and dedicated meta-analyses suggests that SGLT2i also reduce the incidence of new-onset chronic kidney disease (CKD) and albuminuria in participants with preserved kidney function, supporting a role in primary prevention. SUMMARY: SGLT2 inhibitors represent a paradigm shift in nephrology, offering both preventive and disease-modifying effects and establishing a new foundation for CKD risk reduction in high-risk populations.