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SGLT2 inhibitors attenuate urinary EGF decline and correlate with improved outcomes in chronic kidney diseaseNew Kidney Health Marker Helps Predict Success of SGLT2 Inhibitor Treatment

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Key Takeaway
Note that SGLT2 inhibitors attenuate urinary EGF decline, which may reflect improved tubular health in CKD patients.

The study investigated the impact of SGLT2 inhibitors on renal outcomes and the behavior of urinary EGF, a biomarker of tubular health, in patients with chronic kidney disease. The analysis combined data from multiple trials to observe how SGLT2 inhibitors influenced both the risk of composite kidney outcomes and the annual decline of urinary EGF levels.

Findings indicated that higher baseline urinary EGF levels were associated with a lower risk of composite kidney outcomes. Furthermore, SGLT2 inhibitors were shown to attenuate the annual decline of urinary EGF compared to placebo. Patients who experienced an increase or a stabilized urinary EGF level from baseline to the one-year mark also showed a lower risk of adverse kidney outcomes.

While the results were consistent across multiple trials, the authors note that urinary EGF is an independent biomarker of tubular health rather than a direct replacement for albuminuria. The study does not establish a direct causal link regarding tubular repair. Clinically, these findings suggest that urinary EGF may provide valuable insights into the protective effects of SGLT2 inhibitors on the renal tubules.

Doctors are looking for better ways to monitor kidney health in people with chronic kidney disease and type 2 diabetes. A new study looked at a specific marker in urine called uEGF/Cr. This marker helps doctors see how well the small tubes in the kidneys are working. When this marker is high, it usually means the kidneys are healthier and are less likely to fail over time.

Patients in the study were given a type of medication called SGLT2 inhibitors. These drugs are often used to help manage blood sugar and protect the kidneys. The study combined results from three large clinical trials to see how this medication affected the urine marker. The researchers found that patients who started with a higher level of this marker had a much lower risk of serious kidney problems.

One of the most important findings was how the medicine affected the urine marker over a year. Usually, this marker drops as kidney disease gets worse. However, patients taking the SGLT2 inhibitors saw their levels stay much steadier compared to those taking a dummy pill. This suggests that the medication helps protect the specific parts of the kidney that this marker measures.

Furthermore, the study showed that if a patient's urine marker increased or stayed stable over the first year, they had a lower risk of kidney failure. This makes the urine test a very useful tool for doctors. It can help them see if a treatment is working well and help them predict which patients might need extra care. This marker is a reliable way to check kidney health independently of other common tests.

In conclusion, the uEGF/Cr test provides a clear picture of kidney health. It helps doctors understand how well SGLT2 inhibitors are protecting the kidneys. By using this test, medical teams can better monitor their patients and provide more personalized care for those living with chronic kidney disease and diabetes.

What this means for you:
A new urine test helps doctors track kidney health and see how well SGLT2 medications protect the kidneys.

Study Details

Study typeRct
Sample sizen = 5,978
EvidenceLevel 2
Follow-up12.0 mo
PublishedOct 2026
View Original Abstract ↓
KEY POINTS: Lower urinary EGF levels, normalized to urinary creatinine, reflected impaired tubular health and were associated with higher kidney risk across CKD. Sodium-glucose cotransporter 2 inhibitors attenuated the decline in urinary EGF-creatinine ratio observed with placebo, supporting a role in maintaining tubular health. Early increases in urinary EGF-creatinine ratio were linked to lower kidney risk, adding prognostic value beyond albuminuria. BACKGROUND: Urinary EGF is a marker of tubular repair capacity. Lower urinary EGF-creatinine ratio (uEGF/Cr) levels associate with kidney disease progression in patients with type 2 diabetes at early stages of CKD. In these patients, sodium-glucose cotransporter 2 inhibitors (SGLT2is) are associated with increased tubular EGF expression. In this study, we aimed to extend these findings to a broad CKD population with and without type 2 diabetes at various stages of CKD. METHODS: We measured EGF in stored urine samples at baseline and year 1 in participants from the Canagliflozin Cardiovascular Assessment Study (CANVAS), Canagliflozin and Renal Events in Diabetes with Established Nephropathy Clinical Evaluation (CREDENCE), and Dapagliflozin and Prevention of Adverse Outcomes in CKD (DAPA-CKD) clinical trials. Associations of baseline and longitudinal uEGF/Cr with the composite kidney outcome (sustained ≥40% eGFR decline, kidney failure, or kidney-related death) were assessed using multivariable Cox regression, and associations with annual eGFR decline using a two-slope linear mixed-effects model. Treatment effects of SGLT2i on uEGF/Cr over time were analyzed with analysis of covariance. RESULTS: In participants with type 2 diabetes from the CANVAS and CREDENCE trials ( N =5978), higher baseline uEGF/Cr was associated with a lower risk of the composite kidney outcome (hazard ratio per two-fold higher uEGF/Cr, 0.87 [95% confidence interval, 0.80 to 0.94]). SGLT2i attenuated the decline in uEGF/Cr over 1 year compared with placebo by 6.7% (95% confidence interval, 2.5 to 10.8). Increases in uEGF/Cr from baseline to year 1 were independently associated with a lower risk of the kidney outcome, even after accounting for 1-year changes in albuminuria, eGFR, and other clinical variables. Replication analyses showed similar results in the DAPA-CKD trial ( N =2450), with consistent findings in participants with and without diabetes. CONCLUSIONS: These results extend previous findings, supporting uEGF/Cr as a robust, independent biomarker of tubular health and kidney risk across diverse CKD populations. SGLT2i attenuated uEGF/Cr decline, and early changes in uEGF/Cr provided prognostic information beyond albuminuria.
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