Broader Adoption of SGLT2 Inhibitors in Clinical Practice

Over the past decade, the indications for sodium-glucose cotransporter 2 (SGLT2) inhibitors for kidney and cardiovascular risk reduction have expanded, driven by clinical trial evidence demonstrating their efficacy among individuals with chronic kidney disease (CKD), heart failure, diabetes, and atherosclerotic cardiovascular disease. Current clinical practice guidelines for people with CKD recommend their use for individuals with an estimated glomerular filtration rate (eGFR) greater than or equal to 20 mL/min/1.73 m2 who also have type 2 diabetes, heart failure, or a urine albumin to creatinine ratio (UACR) greater than 200 mg/g. A major unanswered question is whether SGLT2 inhibitors would improve kidney outcomes among those with lower degrees of albuminuria or more advanced CKD than recommended by current guidelines. To address this crucial knowledge gap, the SGLT2 Inhibitor Meta-Analysis Cardio-Renal Trialists’ Consortium (SMART-C) conducted 2 companion meta-analyses of randomized placebo-controlled SGLT2 inhibitor trials to assess the effect on kidney outcomes among key subgroups of patients and report their results in this issue of JAMA.