SGLT-2 Inhibitors in the Treatment of Chronic Kidney Disease in Non-Diabetic Patients
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Introduction: Chronic kidney disease (CKD) is one of the most prevalent conditions worldwide and is projected to become a leading cause of morbidity and mortality in the coming decades. Until a few decades ago, the only established therapies shown to modify disease progression were renin–angiotensin system (RAS) inhibitors. However, newer agents such as sodium–glucose cotransporter 2 (SGLT-2) inhibitors have become a cornerstone of CKD management in both diabetic and non-diabetic patients, due to their protective effects on renal and cardiovascular outcomes.
Current evidence: SGLT-2 inhibitors reduce renal glucose reabsorption, leading to glucosuria. In addition, they lower intraglomerular pressure, thereby protecting the kidney from hyperfiltration-related damage, and promote natriuresis, which reduces plasma volume and blood pressure. Multiple studies have demonstrated their efficacy in preventing or delaying CKD progression, reducing cardiovascular mortality, hospitalizations, and heart failure, and improving quality of life in selected patients. However, their protective effects have not been consistently demonstrated in patients with prior stroke.
Conclusion: To date, SGLT-2 inhibitors are among the most effective therapies for slowing CKD progression. Their benefits have been consistent across multiple subgroups, particularly in patients with proteinuric CKD, both in diabetic and non-diabetic populations, as supported by randomized clinical trials and meta-analyses.
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