Kidney Diseases · Published 2026-07-14 · DOI 10.1159/000553450
Xueqi Wang, Jie Wang, Shuwen Zhou, Ziyao Yang, Zhiyu Duan, Yong Wang, Zheyi Dong, Jie Wu, Xiangmei Chen, Guangyan Cai
Introduction： Sodium-glucose cotransporter 2 inhibitors (SGLT2is) are crucial in managing proteinuria in chronic kidney disease (CKD), yet individual responses vary. Whether urinary glucose excretion, a direct pharmacodynamic marker of SGLT2is, could predict proteinuria reduction efficacy remains unclear and has not been specifically investigated. Methods： We enrolled 277 CKD patients treated with empagliflozin (10mg/day) between July 2024 and September 2025 at a single center, stratifying them into low (<46.4 mmol/L, n=69) and high (≥46.4 mmol/L, n=208) urinary glucose groups by 24-hour urinary glucose levels after 3 months of treatment. We evaluated changes in proteinuria levels following 3 and 6 months of medication across the different urinary glucose groups. Changes in laboratory values over time were analyzed using paired Wilcoxon signed-rank tests. Results： Proteinuria was significantly reduced at both 3 [−0.42 g/24 h (95% CI −0.55 to −0.32)] and 6 months [−0.46 g/24 h (95% CI −0.61 to −0.33)] after treatment initiation. After adjusting for covariates, urinary glucose excretion predicted proteinuria reduction from 3 to 6 months (β=2.47, 95% CI: 0.49-4.45, p=0.015), with higher urinary glucose correlating with greater proteinuria decline. The high urinary glucose group had significant proteinuria reduction from baseline at 3 and 6 months (p<0.001), unlike the low group. Following propensity-score adjustment for age, sex, and Body Mass Index (BMI), baseline estimated glomerular filtration rate (eGFR), and renin-angiotensin-aldosterone system (RAAS) inhibitors use, a significantly higher relative risk of ≥30% proteinuria reduction in the high urinary glucose group (RR=2.82, 95% CI: 1.20-6.65, p=0.017), particularly in patients with baseline proteinuria ≥1g/24h. Urinary glucose concentration was weakly positively correlated with 6-month eGFR change (r=0.17, p=0.011). Conclusions： Urinary glucose concentration can serve as a predictor of SGLT2i-mediated proteinuria reduction, providing a practical clinical reference for personalized CKD management.
Abstract from DOAJ. Public domain (CC0 1.0).
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Wang, X., Wang, J., Zhou, S., et al. (2026). Urinary Glucose Concentration as a Predictor of Proteinuria Reduction in CKD Patients Treated with SGLT2 Inhibitors. Kidney Diseases. https://doi.org/10.1159/000553450