JAMA

Kidney Week 2025: SGLT2i use may slow kidney disease progression, regardless of baseline eGFR, albuminuria

November 13, 2025

SGLT2 inhibitors significantly lower the risk of chronic kidney disease (CKD) progression, acute kidney injury, and kidney failure regardless of baseline eGFR or albuminuria levels. These findings, presented at Kidney Week 2025, support broader application in clinical practice for patients with T2DM, CKD, or heart failure.

Study details: The analysis pooled data from 70,361 participants across 10 randomized, double-blind, placebo-controlled trials from the SMART-C consortium, focusing on SGLT2 inhibitors vs. placebo. Key subgroups were defined by baseline eGFR and urinary albumin-to-creatinine ratio (UACR) categories. Primary outcome was CKD progression (defined as ≥50% reduction in eGFR, kidney failure, or kidney-related death); other outcomes included annual rate of eGFR decline and kidney failure.

Results: SGLT2 inhibitors reduced the risk of CKD progression by 38% (25.4 vs. 40.3 events per 1,000 patient-years; hazard ratio [HR], 0.62; 95% confidence interval [CI] 0.57–0.68), with consistent benefit across all eGFR and UACR subgroups.

Risk reduction by baseline eGFR (P for trend=-0.16):

• ≥60 mL/min/1.73 m²: HR 0.61
• 45–<60 mL/min/1.73 m²: HR 0.57
• 30–<45 mL/min/1.73 m²: HR 0.64
• <30 mL/min/1.73 m²: HR 0.71

Risk reduction by baseline UACR (P for trend =0.49):

• ≤30 mg/g: HR 0.58
• >30–300 mg/g: HR 0.74
• >300 mg/g: HR 0.57

Benefits were similar in patients with and without diabetes.

Source:

Neuen BL, et al; SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium (SMART-C). (2025, November 7). JAMA. SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria: A Meta-Analysis. https://pubmed.ncbi.nlm.nih.gov/41203232/