SGLT2 Inhibitors in Diabetic Kidney Disease

Abstract

Introduction: Diabetic kidney disease (DKD) is a leading cause of end-stage renal disease. SGLT2 inhibitors have emerged as potential renoprotective agents beyond glycemic control. Methods: A systematic literature search was conducted in PubMed and Scopus (2015–2024) for randomized controlled trials and cohort studies on SGLT2 inhibitors in DKD. Results: Fifteen studies including 38,000 patients showed that SGLT2 inhibitors reduced albuminuria by 30–40% and slowed eGFR decline by 2–3 mL/min/year compared to placebo. Risk of ESRD progression decreased by 35%. Discussion: The renoprotective effect appears independent of hypoglycemic action, involving reduced intraglomerular pressure, attenuated tubular hypoxia, and anti-inflammatory pathways. Adverse effects (genital infections, diabetic ketoacidosis) were infrequent but require monitoring. Conclusion: SGLT2 inhibitors are effective for slowing DKD progression and should be considered standard therapy.