Table 1 Recent chronic kidney disease randomized clinical trials of SGLT2is and selective nonsteroidal mineralocorticoid receptor antagonist

EMPA-REG [22]

Empagliflozin 10 mg daily or 25 mg daily vs placebo

7020

Type II diabetic patients with established CV disease and eGFR > 30 mL/min/1.73 m² with body mass index < 45 and HgA1c 7–9%

Composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke

Renal outcomes: Progression to macroalbuminuria, doubling serum creatinine, renal replacement therapy or death from renal disease

3.1 years

- Primary endpoint:

14% lower in canagliflozin group (hazard ratio, 0.86; 95.02% CI, 0.74 to 0.99)

- Secondary endpoint:

39% lower in empagliflozin group (hazard ratio, 0.61; 95% CI, 0.53 to 0.70)

CREDENCE [23]

All patients on RAAS blockade agent

Canagliflozin 100 mg daily s placebo

4401

Type II diabetic patients with eGFR 30–89 mL/min/1.73 m² and urine albumin/creatinine ratio between > 300 and 5000 mg/g

Composite of end-stage kidney disease, doubling of serum creatinine, or kidney/cardiovascular-related death

Composite of cardiovascular death, myocardial infarction, stroke, and hospitalization for heart failure

2.62 years

- Primary endpoint:

30% lower in canagliflozin group (hazard ratio, 0.70; 95% CI, 0.59 to 0.82)

- Secondary endpoint:

39% lower in canagliflozin group (hazard ratio, 0.61; 95% CI, 0.47 to 0.80)

DAPA-CKD [21]

All patients on RAAS blockade agent for at least four weeks

Dapagliflozin 10 mg daily vs placebo

4304

eGFR between 25 and 75 mL/min/1.73 m² and urinary albumin-to-creatinine ratio of 200 to 5000 mg/g

67% of patients had diabetes mellitus type 2

Composite of sustained decline in eGFR of at least 50%, end-stage kidney disease, or death from kidney or cardiovascular causes

Composite of death from cardiovascular causes or hospitalization for heart failure

2.4 years

- Primary endpoint:

39% lower in the dapagliflozin group (hazard ratio, 0.61; 95% CI, 0.51 to 0.72)

- Primary endpoint in DKD participants: 36% lower in dapagliflozin group (hazard ratio 0.64; 95% CI, 0.52 to 0.79)

- Primary endpoint in CKD without diabetes: 50% lower in dapagliflozin group (hazard ratio 0.50 95% CI, 0.35 to 0.72)

- Secondary endpoint:

29% lower in dapagliflozin group (hazard ratio 0.71 (95% CI, 0.55 to 0.92)

FIDELIO-DKD [24]

All patients on maximally tolerated RAAS blockade agent

Finerenone 10 to 20 mg daily vs placebo

5734

DKD patients with either urinary albumin-to-creatinine ratio of 30 to less than 300 mg/g, eGFR between 25 and 59 mL/min/1.73 m² and diabetic retinopathy or had a urinary albumin-to-creatinine ratio between 300 and 5000 mg/g with eGFR of 25 to 74 mL/min/1.73 m²

Composite of kidney failure, a sustained eGFR decrease of at least 40%, or death from renal causes

Cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or heart failure-related hospitalization

2.6 years

- Primary endpoint:

18% lower in the finerenone group (hazard ratio, 0.82; 95% CI, 0.73 to 0.93)

- Secondary endpoint:

14% lower in the finerenone group (hazard ratio, 0.86; 95% CI, 0.75 to 0.99)