Supplementary Material for: Influence of SGLT2i on renal progression in CKD patients: A multicenter real-world study in China

Introduction: Although large randomized control trials have established the renal benefits of sodium–glucose cotransporter-2 inhibitors (SGLT2i) in chronic kidney disease (CKD), real-world evidence in Chinese CKD populations remains scarce. Here we report a multicenter real-world retrospective cohort study of SGLT2i use in hospitalized CKD patients in China.
Methods: We enrolled 155,053 adults with CKD from the China Renal Data System (CRDS) databases (January 2002-January 2023). We included patients treated with SGLT2i for at least 3 months. SGLT2i users and nonusers were matched (1:2) using propensity score matching (PSM). The main outcomes included renal, safety, and clinical outcomes. Renal outcomes included the first occurrence of CKD progression, end-stage kidney disease (ESKD), or composite outcomes. Multivariable Cox regression models and cumulative incidence were estimated post-PSM.
Results: Overall, the core analysis included 1477 SGLT2i users and 2674 nonusers. The progression of CKD (HR 0.81, 95% confidence interval [CI] 0.69-0.95, P < 0.01), incidence of ESKD (HR 0.26, 95% CI 0.18-0.37, P < 0.001), and composite renal outcome (HR 0.68, 95% CI 0.59-0.77, P < 0.001) were significantly lower in the SGLT2i group compared to the non-SGLT2i group. Additionally, the SGLT2i group experienced lower rates of heart failure, stroke, transient ischemic attack, severe hypoglycemia, and urinary tract infection, but a higher risk of acute pancreatitis compared to the non-SGLT2i group. Additionally, eGFR remains better preserved over 3 years in CKD patients treated with SGLT2i.
Conclusion: These findings suggest that SGLT2i offers substantial renal and cardiovascular benefits for Chinese CKD patients.