The Primary Preventive Effect of sodium–glucose cotransporter inhibitors Inhibitors on Chronic Kidney Disease in Patients with Type 2 Diabetes: A Systematic Review and Meta-analysis

Zhenlin Zhang¹Qingxing Xie²Ziwei Ye²Fang Zhang¹Jing Li²Yuwei Zhang¹Qingguo Lu²Suming Shen¹Nanwei Tong^2*

• ¹Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, China
• ²Sichuan University West China Hospital Department of Endocrinology and Metabolism, Chengdu, China

To assess the efficacy of Sodium–glucose cotransporter inhibitors (SGLTis) in the primary prevention (PP) of chronic kidney disease (CKD) among patients with type 2 diabetes (T2D). Method Literature was retrieved from MEDLINE, Embase, and Cochrane databases up to January 1, 2025. Eligible studies included randomized controlled trials (RCTs) or their subgroups and observational studies involving T2D patients without CKD treated with SGLTis for ≥1 year, focusing on CKD-related composite outcomes. Seven articles meeting inclusion criteria were included. The hazard ratio (RR) was calculated, and the degree of heterogeneity was assessed. Subsequently, 95% confidence intervals (95% CI) were computed accordingly. Result In RCTs, 15,228 eligible participants received SGLTis and 12,736 received placebo. Meta-analysis using random-effects models showed that SGLTis reduced CKD-related composite outcomes by 53% (RR 0.47, 95% CI 0.39, 0.57; P < 0.0001) with low heterogeneity (I² = 6%). Observational data also indicated a lower CKD incidence (0.6–0.7%) with SGLTis versus other glucose-lowering therapies in individuals with CKD PP. Conclusions SGLTis significantly lower CKD incidence in T2D patients without baseline CKD. Further RCTs are necessary to validate our conclusions.