29/11/2025
SGLT2i with Mineralocorticoid Receptor Antagonist (MRA) combination therapy (SMCT) in superior to either agents alone in reducing urine protein loss in people with chronic kidney disease (CKD)
Analysis of 15,836 adults with CKD from 8 studies.
SMCT has:
12.83% greater reduction in urine albumin creatinine ratio (uACR) w.r.t MRA
26.30% greater reduction in UACR w.r.t SGLT2i
Better BP lowering that MRA/SGLT2i alone
Hyperkalemia risk similar to MRA alone, but more than SGLT2i alone
This superior reduction in proteinuria did not translate into reduced all cause mortality.
All cause mortality among SMCT users was similar to MRA alone users, but significantly higher than SGLT2i alone users. This outcome was heavily influenced by data from a single study by Provenzano et al which reported that the all-cause death rates were 11/109 (10.09%) in the dapagliflozin with spironolactone/eplerenone combination therapy group as compared to 90/2043 (4.41%) in the dapagliflozin alone group.
DETAILS AT: https://www.sciencedirect.com/science/article/abs/pii/S1871402125001511
