Abstract:

Chronic kidney disease (CKD) is one of the most serious challenges facing modern 
medicine. According to the World Health Organization, over 850 million people worldwide 
suffer from varying degrees of kidney damage, and approximately 1 in 10 adults has reduced 
renal reserve [1]. The purpose of this report is to: 
1. To review the scientific literature and summarize the clinical significance of SGLT2 inhibitors 
in the treatment of patients with chronic kidney disease.  
2. 
To present personal clinical experience with the use of SGLT2 inhibitors and 
mineralocorticoid receptor antagonists (MRAs). A thorough analysis of the latest studies related 
to SGLT2 inhibitors and their impact on renal function was performed: 
1. DECLARE–TIMI 58 Mosenzon et al. (Diabetes Care, 2021) analyzed over 17,000 patients 
with type 2 diabetes mellitus. Treatment with an SGLT2 inhibitor led to a significant decrease in 
albumin-to-creatinine ratio (UACR) in all baseline categories [14]. - Improvement in the UACR category was reported at a 45% higher frequency, - Worsening of albuminuria was reduced by 18%, - The effect was independent of glycemic control. 
DAPA-CKD Jongs et al. (Lancet Diabetes Endocrinol., 2021) included 4304 patients with CKD, 
of whom 32% were without diabetes [15]. 
The results showed that SGLT2 inhibitors: - reduced mean albuminuria by 29% compared to placebo (p<0.0001), - increased the probability of albuminuria regression by 81%, - and reduced the risk of progression by 59%. 
The combined endpoint (decrease in eGFR ≥50%, end-stage renal disease, or 
renal/cardiovascular death) was reduced by 39% [16]. 
Results from the large FIDELIO-DKD and FIGARO-DKD trials showed that MRAs: - reduce the albumin-to-creatinine ratio (UACR) by about 30% already in the first three months, - reduce the risk of the combined renal endpoint by 18%, - reduce the risk of cardiovascular events by 14% [18, 19] 

Keywords: Chronic kidney disease (CKD), SGLT2 inhibitors, renal injury, nephroprotective 
therapy. 

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