In stage 5 CKD, do SGLT2 ihibitors prevent progression to dialysis?

The 2 minute update looks at a study asking if SGLT2 inhibitors slow progression to dialysis in patients with severe kidney disease.

 

This study is a retrospective cohort study from Taiwan. It included over 47,000 patients with type 2 diabetes and stage 5 chronic kidney disease. Half were on an SGLT-2 inhibitor, and half were not. Follow-up was for roughly 5 years.

 

Of note, the patients on the SGLT-2 inhibitor tended to be sicker. They were about 4.5 years older, and far more had histories of myocardial infarctions and heart failure, and over twice as many were treated with insulin.

 

The patients on SGLT-2 inhibitors were far less likely to progress to dialysis, or to be admitted for acute kidney injury or myocardial infarction. There was a trend to higher mortality, but since those patients were sicker, it’s very unclear if that is due to the SGLT-2 inhibitor, or the fact that they were more likely to have comorbid cardiac conditions, and more likely to be on insulin, indicating worse diabetes.

 

Are SGLT2 inhibitors our new miracle drugs? Of course they have been shown to be quite beneficial in type 2 diabetes as well as heart failure with any ejection fraction. Other studies also show decreased rates of nephrolithiasis and gout flares, as well as decreased all cause mortality in patients with diabetes.

 

Unfortunately, SGLT2 inhibitors are still quite expensive. But dapagliflozin is now available as a generic. So far, the cost is still about half of the brand name version, but expect prices to fall. It appears that when only one company is making a generic version of a medication, prices fall 30-50%, but when 5 companies are making it, prices fall about 95%.

 

Reference:  Yen et al. Sodium-Glucose Cotransporter-2 Inhibitors and the Risk for Dialysys and Cardiovascular Disease in Patients With Stage 5 Chronic Kidney Disease. Ann Intern Med 2024;177:693