COMPARISON OF EFFICACY OF SGLT2 INHIBITORS VERSUS STANDARD THERAPY IN SLOWING CKD PROGRESSION

Abstract

Background: Chronic kidney disease (CKD) is a major global health challenge, commonly associated with hypertension and diabetes, and is characterized by progressive decline in renal function. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as renoprotective agents in addition to standard therapy.

Objectives: To compare the efficacy of SGLT2 inhibitors versus standard therapy in slowing the progression of CKD stages 2–4.

Study Design & Setting: A comparative study conducted at the Department of Nephrology, Shaikh Zayed Hospital, Lahore, from November 2024 to April 2025.

Methodology: A total of 120 patients aged 30–70 years with CKD stages 2–4 was enrolled after informed consent. Patients were randomized into two groups: Group A received standard therapy (ACE inhibitors/ARBs with optimal management of blood pressure, glycemia, and lipids), while Group B received an SGLT2 inhibitor in addition to standard therapy. Baseline demographics, comorbidities, serum creatinine, estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio, fasting blood glucose, and HbA1c were recorded. Patients were followed for six months with repeat renal function assessments at three and six months. The primary outcome was mean change in eGFR, while secondary outcomes included change in proteinuria and occurrence of cardiovascular events. Data were analyzed using SPSS v25. Independent sample t-test and chi-square test were applied, with p ≤ 0.05 considered statistically significant.

Results: The mean age was 55.2 ± 7.9 years in Group A and 54.1 ± 8.6 years in Group B, with males comprising 55.0% and 53.3%, respectively. Baseline mean eGFR was 52.4 ± 9.8 ml/min/1.73m² in Group A and 53.1 ± 8.9 ml/min/1.73m² in Group B. After six months, mean eGFR declined significantly more in Group A (-5.4 ± 3.1 ml/min/1.73m²) compared to Group B (-1.8 ± 2.1 ml/min/1.73m²; p < 0.001). Proteinuria also remained higher in Group A (798.2 ± 207.6 mg/g) than in Group B (486.0 ± 119.7 mg/g; p < 0.001). No significant baseline differences in demographics or comorbidities were observed between groups (p > 0.05).

Conclusion: SGLT2 inhibitors significantly slowed the decline in renal function and reduced proteinuria compared to standard therapy alone in patients with CKD stages 2–4, highlighting their role as effective renoprotective agents.