A Real‐World Cohort Study on the Association of the Use of Sodium‐Glucose Cotransporter‐2 Inhibitor With the Incidence of Chronic Kidney Disease ( CKD ) in Patients With Type 2 Diabetes Mellitus Without CKD Using the SingHealth Diabetes Registry

Background Sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) are well‐established for slowing chronic kidney disease (CKD) progression. However, their role in reducing the incidence of CKD in individuals with diabetes mellitus remains unclear. Objectives We evaluate the association of SGLT2i use with CKD incidence in a pre‐CKD multi‐ethnic Asian population with type 2 diabetes mellitus (T2D) with no CKD. Materials and Methods This retrospective cohort study analysed patients with T2D from 2016 to 2023 using the SingHealth Diabetes Registry. Patients with baseline estimated glomerular filtration rate (eGFR) ≥ 60 mL/min/1.73 m 2 and urinary albumin‐to‐creatinine ratio (uACR) < 30 mg/g were included. Cases and controls were matched based on age, gender, housing type, body mass index, HbA1c, baseline eGFR, renin‐angiotensin‐system inhibitors, metformin and glucagon‐like peptide‐1 receptor agonist using propensity score matching (PSM). Primary outcome was incident CKD and secondary outcomes included eGFR and uACR change over time. We used conditional logistic regression to estimate the odds ratio of incident CKD and mixed‐effects linear regression to assess eGFR change over time. Results Of 21 780 patients, 4450 patients (2225/group) were analysed after PSM. Median baseline eGFR were 103.58 mL/min/1.73 m 2 and 103.53 mL/min/1.73 m 2 in SGLT2i users and non‐users, respectively. SGLT2i users had lower CKD incidence (OR 0.36, 95% CI 0.31–0.42; p < 0.001) compared to non‐users. Longitudinal analysis demonstrated a slower rate of GFR decline and lower uACR increase over time in SGLT2i users. Conclusion SGLT2i use in individuals with T2D and preserved renal function was associated with lower CKD incidence, suggesting its potential preventive role in non‐CKD population.