Abstract: Objective:To investigate the effect of sodium⁃glucose cotransporter 2 inhibitors (SGLT2i) on the rate of estimated glomerular filtration rate (eGFR) decline and the incidence of the composite renal endpoint in patients with diabetic kidney disease (DKD). Methods:This retrospective cohort study included DKD patients who first visited the National Clinical Research Center for Kidney Diseases from January 2018 to August 2020. Participants were divided into the SGLT2i group and the control group receiving other glucose⁃lowering medications based on SGLT2i use. The primary outcome was the between⁃group difference in the slope of eGFR decline. The secondary outcome was the composite renal endpoint, defined as a ≥50% decline in eGFR from baseline or progression to end-stage renal disease (ESRD). Results:A total of 927 patients were included, with 474 in the SGLT2i group and 453 in the control group. After propensity score matching (PSM), 258 patients were included in each group, with balanced baseline characteristics. The median follow⁃up duration were 37 months in the SGLT2i group and 40 months in the control group. Compared with the control group, the rate of eGFR decline in the SGLT2i group was significantly slowed by 3.05 mL/(min·1.73 m²·year) (P<0.001), and the risk of composite renal endpoint was reduced by 47% (hazard ratio [HR]=0.53, 95% confidence interval [CI] 0.32-0.88, P=0.015). Conclusion:The real⁃world study results show that SGLT2i has a significant renal protective effect in patients with type 2 DKD.

Key words: sodium?glucose cotransporter 2 inhibitor, type 2 diabetic nephropathy, estimated glomerular filtration rate, kidney protection