Dapagliflozin enhances kidney function and reduces albuminuria in low-renal-risk T2D patients

Patients with type 2 diabetes (T2D) treated with sodium-glucose co-transport-2 inhibitors (SGLT2i) showed a reduced risk of kidney function loss, even in primary prevention, according to the DARWIN-Renal study.

The DARWIN-Renal study, a retrospective analysis of electronic health records from 48,593 patients between 2015 and 2020 at 50 diabetes outpatient clinics, investigated changes in estimated glomerular filtration rate (eGFR), kidney function loss, and albuminuria. The study compared patients receiving SGLT2i treatments with those on glucagon-like peptide-1 receptor agonists (GLP-1RA).

Following propensity score matching, the study included 5,701 patients in each group. The results, presented by Prof. Gian Paolo Fadini (University of Padova, Italy), showed that SGLT2i significantly slowed the eGFR decline over a median period of 2.2 years [1]. Specifically, the dapagliflozin group experienced a smaller decline in eGFR, averaging a reduction of 1.19 ml/min/1.73 m² compared with the GLP-1RA group (95% CI 0.47-0.99; P=0.001). Creatinine doubling rates were lower in the SGLT2i group than in the GLP-1RA group (hazard ratio 0.64; 95% CI 0.41-0.99; P=0.047). No significant differences were observed in albuminuria changes or the rate of new-onset macroalbuminuria between the groups. Furthermore, the SGLT2i group showed favourable changes in body weight (-1.3 kg) and systolic blood pressure (-1.1 mm Hg) compared with those treated with GLP-1RA.

In conclusion, the study suggests the potential of SGLT2i as the preferred agent for renal protection in patients with T2D over GLP-1RA. Prof. Fadini noted, “Rather than merely comparing these 2 drug classes, the complementary mechanisms of action suggest that combining them could be more beneficial than choosing one over the other.”

1. Fadini GP, et al. Comparative renal outcomes of matched cohorts of patients with type 2 diabetes receiving SGLT-2 inhibitors or GLP-1 receptor agonists under routine care: the DARWIN- Renal study. OP1, EASD 2024, 9-13 September, Madrid, Spain.

Posted on 13 September 202413 September 2024