Efficacy of SGLT2 inhibitors in preventing end-stage kidney disease in patients with IgA nephropathy: a scoping review
Abstract
Objectives: To conduct a scoping review mapping the extent, nature, and consistency of available evidence regarding the effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors on kidney function, proteinuria, kidney outcomes, and mortality in patients with IgA nephropathy (IgAN).
Methods: This scoping review was conducted in accordance with the PRISMA-ScR guidance. Randomized controlled trials (RCTs) including patients with IgAN were identified to characterize high-level efficacy signals. Observational studies, real-world cohorts, and mechanistic investigations were additionally included to contextualize and extend the randomized evidence. Findings were mapped across five predefined outcome domains: acute eGFR dip, chronic eGFR slope, proteinuria reduction, kidney outcomes, and mortality.
Results: Two large randomized controlled trials, DAPA-CKD and EMPA-KIDNEY, provided randomized evidence supporting kidney-protective effects of SGLT2 inhibitors in IgAN subgroups. Complementary observational and real-world studies consistently demonstrated clinically meaningful reductions in proteinuria, stabilization of kidney function trajectories, and mechanistic patterns linking early hemodynamic responses with longer-term renal benefit. Mortality data specific to IgAN remain limited; however, indirect evidence from broader CKD populations suggests biological plausibility for cardiovascular and survival benefits.
Conclusion: The available evidence supporting SGLT2 inhibitors in IgA…
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