Assessing Renoprotective Effects of Empagliflozin and Telmisartan Combination Therapy in Non-albuminuric Diabetic Nephropathy: A Retrospective Cohort Study
Abstract
Background: Non-albuminuric diabetic kidney disease (DKD) can exhibit “silent” loss of estimated glomerular filtration rate (eGFR) despite normal urine albumin. We examined whether sodium-glucose cotransporter 2 (SGLT2) inhibition added to angiotensin receptor blockade is associated with slower eGFR decline in this phenotype. Methods: In this retrospective cohort, adults with type 2 diabetes and a non-albuminuric DKD phenotype (urine albumin-to-creatinine ratio (UACR) <30 mg/g on serial testing, with prespecified evidence supporting DKD when baseline eGFR was 60-89 mL/min/1.73 m2) were grouped as concurrent empagliflozin plus telmisartan (n=60) or telmisartan-based care without any SGLT2 inhibitor (n=60). The primary outcome was annualized eGFR slope estimated from repeated measures using weighted linear mixed-effects models. Results: The analytic cohort included 120 adults with non-albuminuric DKD (empagliflozin + telmisartan, n=60; telmisartan without any SGLT2 inhibitor, n=60). After inverse probability of treatment weighting (IPTW), covariate balance was acceptable (all standardized mean differences <0.10). In weighted linear mixed-effects models, the annualized eGFR slope (negative values indicate decline) was -1.15 mL/min/1.73 m2/year in the empagliflozin + telmisartan group and -2.18 mL/min/1.73 m2/year in the telmisartan-only group, yielding a between-group difference of +1.03 mL/min/1.73 m2/year (slower decline with combination therapy). For event-based outcomes,…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 120 participants or records.
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