Real-world Study on the Effectiveness of Add-on SGLT-2 Inhibitors on the Progression of Chronic Kidney Disease in Non-SGLT-2 Inhibitors Treated Type 2 Diabetes Mellitus

Abstract

Objective: To study the effectiveness on delaying the progression of chronic kidney disease in patients with type 2 diabetes receiving add-on SGLT-2 inhibitors (dapagliflozin and empagliflozin) with the use of non-SGLT-2 inhibitors. Method: This retrospective analytical study collected data from patients with type 2 diabetes at the Central Chest Institute of Thailand between October 1, 2014, and October 31, 2019. The patients were divided into three groups: 1) those with dapagliflozin, 2) those with empagliflozin, and 3) those with only non-SGLT-2 inhibitors. Follow up duration was one year after starting SGLT-2 inhibitors. The progression of chronic kidney disease was determined by the decline of estimated glomerular filtration rate (eGFR) for at least 40% from baseline or the doubling of serum creatinine or having end-stage renal disease. Results: 564 patients with type 2 diabetes in three groups, with 188 patients in each group, qualified the inclusion and exclusion criteria. The numbers of patients with at least 40% decline of eGFR from baseline were nine patients in dapagliflozin group (1.6%), three in empagliflozin group (0.5%) and 14 in non-SGLT-2 inhibitors group (3.7%). The difference reached statistical significance (P = 0.025). One patient (0.2%) in the SGLT-2 inhibitors group and two patients (0.4%) in the non-SGLT-2 inhibitors group had a doubling of serum creatinine (P = 0.366) with no statistically significant difference. None of the ESRD patients were found in the study. Conclusion: SGLT-2 inhibitors could delay the progression of kidney disease, as determined by at least 40% decline of eGFR from baseline, in patients with type 2 diabetes better than non-SGLT-2 inhibitors.