Introduction and Objective: Large trials (CANVAS, EMPA-KIDNEY, DAPA-CKD) showed kidney benefits of SGLT2 inhibitors, mainly in patients with reduced eGFR or overt albuminuria. Effects in early nephropathy with eGFR ≥60 and UACR 30 mg/gCr remain unclear. Methods: From the JDDM registry (n=21,442), we included adults with type 2 diabetes with no SGLT2 inhibitor use before 2015, continuous use or non-use from 2016, UACR measured in 2016, and baseline eGFR ≥60. eGFR slopes were assessed using multivariable linear regression and 1:4 propensity-score matching by baseline eGFR. Results: We analyzed 954 patients (856 non-users, 97 users). Baseline eGFR was similar (77.8 vs 75.1 mL/min/1.73 m²; p=0.40). The annual eGFR slope was steeper in non-users than in users (−1.33 vs 0.06 mL/min/1.73 m²/year; p0.001). In multivariable models, SGLT2 inhibitor use (vs non-use) was associated with a slower decline (β=0.81, p0.001). After matching by baseline eGFR (UACR 10: 200 non-users vs 50 users; UACR 10-30: 236 vs 59), eGFR slopes remained more favorable in users: UACR 10, −1.14 vs 0.007 (p0.05); UACR 10-30, −1.71 vs −0.12 (p0.001). Conclusion: Among people with UACR 30 mg/gCr and preserved eGFR, SGLT2 inhibitors attenuated eGFR decline. In UACR 10 mg/gCr, they modestly improved the slope, though a definitive renoprotective effect was not evident. At UACR 10-30 mg/gCr, they showed a clear renoprotective effect despite preserved eGFR. Disclosure M. Yuki: None. T. Yamazaki: None. M. Sakamoto: Speaker's Bureau; Current; Eli Lilly and Company, Novo Nordisk, Tanabe Pharma Corporation, Boehringer Ingelheim Seiyaku Co., Ltd., MSD K.K., Daiichi Sankyo, Sumitomo Pharma Co., Ltd. Consultant; Current; KAKEHSHI Inc.
YUKI et al. (Fri,) studied this question.