SGLT2 Inhibitors for Renoprotection in Hypertensive Chronic Kidney Disease: Beyond Glycemic Control: A Narrative Review

Background: Chronic kidney disease (CKD) is a major global health burden, with hypertension being a leading driver of disease progression. Despite established renoprotective therapies, substantial residual renal risk persists. Sodium–glucose cotransporter 2 (SGLT2) inhibitors have emerged as important kidney-protective agents beyond glucose lowering. This review summarizes the mechanisms and clinical evidence supporting the renoprotective effects of SGLT2 inhibitors in hypertensive patients with CKD.
Methods: A narrative review was conducted using literature from PubMed, Google Scholar, Scopus, and ScienceDirect published between 2015 and 2025. Studies evaluating the mechanisms, renoprotective effects, and clinical outcomes of SGLT2 inhibitors in patients with CKD and hypertension were included.
Results: SGLT2 inhibitors confer substantial renoprotective benefits through mechanisms independent of glycemic control, including restoration of tubuloglomerular feedback, reduction of intraglomerular pressure, improvement of sodium homeostasis, attenuation of neurohormonal activation, and suppression of inflammatory, oxidative, and fibrotic pathways. Major trials such as CREDENCE, DAPA-CKD, and EMPA-KIDNEY consistently demonstrated reduced albuminuria, slower eGFR decline, lower risk of kidney failure, and improved cardiovascular outcomes across diverse CKD populations, regardless of diabetic status. These agents are increasingly incorporated into contemporary CKD management and may provide additive benefits when combined with other renoprotective therapies.
Conclusion: SGLT2 inhibitors provide significant renoprotection beyond glycemic control by slowing CKD progression, reducing albuminuria, preserving kidney function, and lowering the risk of kidney failure, supporting their role as foundational therapy in hypertensive CKD.