- βSGLT2 inhibitors reduced CKD progression by 38% overall across 70,000+ patients in 10 trials
- βKidney protection was consistent even in Stage 4 CKD (eGFR below 30) and patients with normal urine protein levels
- βFindings support broader routine use of SGLT2 inhibitors beyond current US prescribing guidelines
| Country | Australia |
| Journal | JAMA |
| Year | 2026 |
| Authors | Neuen, Fletcher, Anker |
| PMID | 41203232 |
Australian Research Expands Who May Benefit from a Key Diabetes Drug Class
A study from Australia offers some of the most comprehensive evidence yet that a widely used class of diabetes medications β SGLT2 inhibitors β protects the kidneys across a far broader range of patients than previously confirmed. Researchers at The George Institute for Global Health at the University of New South Wales in Sydney led a sweeping meta-analysis published in JAMA (2026) that pooled data from 10 major clinical trials involving more than 70,000 participants worldwide.
What the Researchers Found
The study examined whether SGLT2 inhibitors β medications like empagliflozin (Jardiance), dapagliflozin (Farxiga), and canagliflozin (Invokana) β reduced kidney disease progression differently depending on a patient's starting kidney function (measured by eGFR) or the amount of protein in their urine (measured by urine albumin-to-creatinine ratio, or UACR).
The results were striking in their consistency. Overall, SGLT2 inhibitors reduced CKD progression by 38% (hazard ratio 0.62). Crucially, this benefit held across every subgroup tested:
- eGFR β₯60 (healthy-to-mildly reduced kidney function): 39% risk reduction
- eGFR 45β59 (mild-to-moderate CKD): 43% risk reduction
- eGFR 30β44 (moderate-to-severe CKD, Stage 3b): 36% risk reduction
- eGFR below 30 (Stage 4 CKD): 29% risk reduction
Similarly, patients with minimal protein in their urine (UACR β€30 mg/g β considered normal) still experienced a 42% reduction in kidney disease progression. This matters because many patients in this lower-risk group have historically been considered unlikely to benefit.
Understanding the Numbers in US Terms
For context, a normal eGFR is generally above 60 mL/min/1.73 mΒ². Stage 4 CKD is defined as an eGFR between 15 and 29 mL/min/1.73 mΒ². In the United States, approximately 37 million Americans have chronic kidney disease, and diabetes remains its leading cause. A UACR above 30 mg/g is considered abnormal; the study found protection even below this threshold.
How This Compares to US Guidelines
Current American Diabetes Association (ADA) Standards of Care already recommend SGLT2 inhibitors for people with type 2 diabetes and CKD, particularly those with elevated albuminuria. However, guidance has been more cautious for patients with Stage 4 CKD or normal-to-low albuminuria. This Australian-led meta-analysis β the largest of its kind β provides robust evidence to potentially support broader use across these groups, reinforcing calls to update prescribing thresholds.
Why This Matters for US Patients
Many American patients with diabetes and early or advanced kidney disease may currently be missing out on a medication that could significantly slow kidney failure. If you have been told SGLT2 inhibitors are "not for you" because your kidney function is too low or your urine protein levels are normal, this research suggests that conversation with your doctor is worth revisiting. The study also included patients with heart failure and CKD without diabetes, broadening who might benefit. Always discuss any medication changes with your healthcare provider before acting on new research.
Study Citation
Neuen B, Fletcher R, Anker S, et al. SGLT2 Inhibitors and Kidney Outcomes by Glomerular Filtration Rate and Albuminuria: A Meta-Analysis. JAMA. 2026. DOI: 10.1001/jama.2025.20834. PMID: 41203232.