Is any of the SGLT-2 inhibitors more “kidney friendly” than others?

Jürgen Floege, MD, is a professor of medicine, director of the Division of Nephrology and Clinical Immunology at the University Hospital RWTH Aachen, Germany, and Distinguished Fellow of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA).

Is any of the sodium-glucose cotransporter-2 (SGLT-2) inhibitors more “kidney friendly” and should therefore be preferred by nephrologists?

No, I don’t believe so. SGLT-2 inhibitors cause glucosuria and that relieves the kidney from, let’s say, work—the work of reabsorbing glucose. And in this respect they’re all the same, so I don’t see any reason to have a particular preference.

In addition, in a few weeks, we will hear the outcome of the EMPA-KIDNEY study [doi:10.1056/NEJMoa2204233], which should tell us whether empagliflozin, like dapagliflozin, protects the kidneys. And since the study was terminated early due to overwhelming success, I’m very confident that we have a class effect here and not an effect of single drugs.