Kidney outcomes of systemic lupus erythematosus patients treated with SGLT2 inhibitors: A national cohort study

Objectives

To evaluate the impact of SGLT2 inhibitors on the estimated glomerular filtration rate (eGFR) over time in patients with systemic lupus erythematosus (SLE).

Methods

This was a retrospective real-world analysis using the Clalit Health Services SLE registry (CHS-SLE registry), a national cohort of 4354 SLE patients. We conducted a two-step propensity-score matching analysis of SLE patients who initiated SGLT2 inhibitors between 2015 and 2022. The primary outcome was the eGFR at 24 months. We also assessed the event-free probability for SGLT2 inhibitor users versus non-users regarding a rapid decline in eGFR, ≥30 % eGFR decline, new-onset end-stage kidney disease (ESKD), and a composite of these outcomes at 24 months. Additionally, we performed subgroup analyses of eGFR changes stratified by baseline patient characteristics.

Results

At baseline, 260 SGLT2 inhibitor users were matched with 413 non-users. The baseline eGFR after matching was similar between the two groups (71.0 vs. 70.0 mL/min/1.73 m², p = 0.7). At 24 months, the eGFR was 71.2 mL/min/1.73 m² (95 % CI 69.1–74.9) in the SGLT2 inhibitor users and 65.4 mL/min/1.73 m² (95 % CI 62.5–68.4) in the non-user group (p < 0.001). The use of SGLT2 inhibitors was associated with a reduced risk of developing a rapid decline in eGFR (HR 0.74, 95 % CI 0.59–0.92, p = 0.01), and a reduced risk of developing the composite outcome (HR 0.72, 95 % CI 0.53–0.97, p = 0.03).

Conclusions

In SLE patients, exposure to SGLT2 inhibitors was associated with improved kidney function and a reduced risk of developing adverse kidney outcomes.