Diabetic nephropathy in Saudi Arabia: Current challenges and management strategies in the era of sodium-glucose co-transporter inhibitors

Diabetic nephropathy (DN) represents a major public health challenge in Saudi Arabia, where diabetes mellitus prevalence ranks among the highest globally at approximately 18.3%. This condition has emerged as the leading cause of chronic kidney disease and end-stage renal disease, significantly impacting the healthcare system and patient quality of life. The pathophysiology involves complex mechanisms including hemodynamic changes, metabolic alterations, and inflammatory processes that progressively damage renal structures. Traditional management strategies have focused on glycemic control, blood pressure management with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and cardiovascular risk reduction. However, the introduction of sodium-glucose co-transporter 2 (SGLT2) inhibitors has revolutionized nephroprotective therapy, demonstrating significant benefits in slowing disease progression and reducing cardiovascular mortality. Recent landmark trials including CREDENCE, DAPA-CKD, and EMPA-KIDNEY have established SGLT2 inhibitors as cornerstone therapy for DN. In Saudi Arabia, implementation challenges include healthcare accessibility, medication costs, patient adherence, and the need for specialized nephrology services. The economic burden is substantial, with dialysis and transplantation costs consuming significant healthcare resources. Early detection through routine screening programs, comprehensive management approaches incorporating lifestyle modifications, optimal pharmacological therapy, and patient education are essential. This review examines the current state of DN in Saudi Arabia, evaluates evidence-based management strategies with emphasis on SGLT2 inhibitors, and discusses healthcare system considerations for improving outcomes in this high-risk population.