Kidney and cardiovascular protection with sodium-glucose cotransporter 2 inhibitors (SGLT2i) may begin before chronic kidney disease (CKD) becomes clinically apparent. In a retrospective cohort study published in Diabetes Research and Clinical Practice, adults with type 2 diabetes mellitus (T2DM) without baseline CKD who used SGLT2i had lower risks of incident kidney disease, cardiovascular events, and death versus non-users.

Using Taiwan’s National Health Insurance Research Database from 2016 to 2021, the analysis identified 11,617 matched pairs of SGLT2i users and non-users after 1:1 propensity score matching. All participants had T2DM without preexisting CKD at baseline. Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for clinical outcomes.

SGLT2i use was associated with lower risk of incident CKD (aHR 0.86; 95% confidence interval [CI] 0.83-0.89), macroalbuminuria (aHR 0.85; 95% CI 0.82–0.89), acute kidney injury (AKI) (aHR 0.71; 95% CI 0.59-0.86), and dialysis (aHR 0.46; 95% CI 0.20-1.06).

Cardiovascular outcomes were also lower among SGLT2i users, including major adverse cardiovascular events (MACE) (aHR 0.84; 95% CI 0.76-0.92), hospitalization for heart failure (aHR 0.85; 95% CI 0.76-0.96), and myocardial infarction (MI) (aHR 0.68; 95% CI 0.52–0.89). All-cause mortality was reduced as well (aHR 0.73; 95% CI 0.64–0.82).

The findings suggest that SGLT2i use in T2DM may provide renal and cardiovascular protection even before the onset of CKD.