This retrospective, 1:1 propensity-matched cohort study evaluated longitudinal changes in predicted cardiorenal risk after initiation of SGLT2 inhibitors (SGLT2i) in patients with chronic kidney disease (CKD). The analytic sample included 132 patients, split evenly into 66 individuals with type 2 diabetes (T2D) and 66 without T2D. Participants were followed for 12 months after starting an SGLT2i. The investigators calculated validated cardiovascular and renal risk scores at baseline and at 12 months and used logistic regression to identify predictors of score improvement.
Three validated instruments were applied to quantify predicted cardiorenal risk:
All three scores were computed at baseline (pre‑SGLT2i) and at 12 months post‑initiation. The study compared within‑group changes and examined which baseline or on‑treatment variables predicted improvement in cardiovascular risk estimates.
After 12 months of SGLT2i therapy, reported changes in cardiovascular risk estimates differed by diabetes status:
In patients with type 2 diabetes, PREVENT scores declined significantly (Δ -2.95, P = .001), indicating an improvement in predicted cardiovascular risk at 12 months. SCORE2‑CKD also decreased in the diabetic subgroup (Δ -3.85, 95% CI -4.35 to -3.35, P = .023).
In patients without diabetes, PREVENT did not change significantly (Δ -0.80, P = .396). Unexpectedly, SCORE2‑CKD increased in the non‑diabetic group (Δ +3.25, P = .044).
The authors highlight that individuals with higher baseline cardiovascular risk experienced the most pronounced declines in both PREVENT and SCORE2‑CKD, suggesting that baseline risk stratification influenced magnitude of predicted risk change.
Across both diabetic and non‑diabetic subgroups, KFRE-derived renal risk declined significantly at 12 months following SGLT2i initiation. This consistent reduction in predicted kidney‑failure risk was observed regardless of diabetes status in the matched cohort and represents a primary finding supporting favorable renal risk projections after SGLT2i therapy in this real‑world CKD population.
In analyses across the entire cohort, variation in estimated glomerular filtration rate (eGFR) and in proteinuria during follow‑up were independent predictors of improvement in cardiovascular risk‑score estimates. The study used logistic regression to identify these associations. This finding links on‑treatment changes in kidney function markers with shifts in predicted cardiovascular risk.
The study reports that initiation of SGLT2 inhibitors in a real‑world CKD cohort was associated with favorable changes in predicted renal risk (KFRE) and with improvements in some cardiovascular risk scores, particularly among patients with type 2 diabetes and those with higher baseline cardiovascular risk. The association between improvement in CV risk estimates and reductions in proteinuria or stabilization/improvement of eGFR underscores the interconnected nature of renal and cardiovascular risk in CKD.
The authors emphasize these results reflect changes in predicted risk scores rather than observed reductions in cardiovascular events. Thus, these findings should be considered exploratory and hypothesis‑generating rather than confirmatory evidence of reduced clinical event rates.
As reported in the source article, the results derive from a retrospective, propensity‑matched observational cohort. The authors explicitly caution that the observed changes are in predicted risk scores and are not direct evidence of fewer clinical cardiovascular events. Additional limitations typical of observational designs—such as residual confounding, limited generalizability, and reliance on predicted rather than observed outcomes—apply, though specific numerical or methodological limitations beyond those summarized here are detailed in the full article.
Overall, this study provides real‑world evidence that SGLT2i initiation in CKD patients is associated with improved predictions of kidney‑failure risk by KFRE and with heterogeneous changes in cardiovascular risk estimates by PREVENT and SCORE2‑CKD, with the greatest cardiorenal score improvements seen in patients with diabetes and those at higher baseline risk.