From the Guidelines
The minimum Glomerular Filtration Rate (GFR) for Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors is 20 mL/min/1.73 m².
Key Points
- The use of SGLT2 inhibitors in individuals with eGFR >20 mL/min/1.73 m² and UACR >200 mg/g creatinine is recommended to reduce CKD progression and cardiovascular events 1.
- The DAPA-CKD and EMPEROR trials suggest that SGLT2 inhibitors are safe and effective at eGFR levels >20 mL/min/1.73 m² 1.
- The KDIGO 2022 guideline recommends continuing SGLT2 inhibitors as long as tolerated, even if eGFR falls below 20 mL/min/1.73 m², until kidney replacement therapy is initiated 1.
- The 2025 Standards of Care in Diabetes recommend using an SGLT2 inhibitor or GLP-1 RA with demonstrated benefit in adults with type 2 diabetes who have CKD (with confirmed eGFR 20–60 mL/min/1.73 m² and/or albuminuria) for both glycemic management and slowing progression of CKD and reduction in cardiovascular events 1.
Important Considerations
- The glycemic benefits of SGLT2 inhibitors are reduced at eGFR <45 mL/min/1.73 m² 1.
- SGLT2 inhibitor doses are modified in patients with impaired renal function because the medications are less effective in lowering glucose concentrations when renal function is impaired 1.
From the Research
Minimum Glomerular Filtration Rate (GFR) for SGLT2 Inhibitors
The minimum GFR for the use of Sodium-Glucose Linked Transporter 2 (SGLT2) inhibitors is not explicitly stated in the provided studies. However, the studies suggest that SGLT2 inhibitors can be beneficial for patients with chronic kidney disease (CKD) and those with reduced GFR.
GFR Thresholds for SGLT2 Inhibitor Use
- The studies do not provide a specific minimum GFR threshold for the use of SGLT2 inhibitors 2, 3, 4, 5, 6.
- However, the studies suggest that SGLT2 inhibitors can be used in patients with eGFR <60 ml/min/1.73 m2, with some studies showing benefits in patients with eGFR <45 ml/min/1.73 m2 3, 4, 5.
- One study found that SGLT2 inhibitors reduced the risk of acute kidney injury (AKI) and improved the rate of change in eGFR in patients with CKD, including those with eGFR <60 ml/min/1.73 m2 3.
Key Findings
- SGLT2 inhibitors can slow the progression of diabetic kidney disease (DKD) and reduce the risk of AKI 2, 3, 4, 5.
- The benefits of SGLT2 inhibitors on kidney outcomes are greater in patients with lower eGFR and higher albuminuria 5.
- SGLT2 inhibitors can improve glomerular hemodynamics and reduce glomerular capillary pressure (PGC) in diabetic rats 6.