Evaluating the Renoprotective Effects of Pharmacological Interventions in Diabetic Kidney Disease: A Comparative Study

Abstract

Background: Diabetic kidney disease (DKD) is a leading cause of chronic kidney disease and end-stage renal failure. Multiple pharmacological classes are used for renoprotection, but direct comparative evidence across established therapies remains limited. The study aims to compare the renoprotective effects of ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), SGLT2 inhibitors (SGLT2i), GLP-1 receptor agonists (GLP-1 RA), and mineralocorticoid receptor antagonists (MRA) in patients with DKD, using standardized renal outcomes. Methods: In this comparative observational study, 50 adults with DKD were allocated to five treatment groups (n = 10 per group) based on their ongoing pharmacotherapy. eGFR and urinary albumin-to-creatinine ratio (UACR) were recorded at baseline and after 10–13 months of follow-up. Primary outcomes were changes in eGFR (ΔeGFR) and UACR (ΔUACR). Between-group differences were assessed using one-way ANOVA. Results: All groups showed some change in renal parameters over follow-up, but the magnitude differed substantially by treatment class. SGLT2i and GLP-1 RA groups exhibited minimal decline in eGFR and the largest reductions in UACR, while ACEi, ARB, and MRA showed more pronounced eGFR loss and smaller albuminuria reductions. ANOVA revealed statistically significant differences between groups for both ΔeGFR and ΔUACR (p < 0.001). Conclusions: Pharmacological class significantly influences renal outcomes in DKD. SGLT2 inhibitors and GLP-1 receptor agonists demonstrated superior short-term renoprotective effects and should be prioritized in eligible patients, although validation in larger, longer-term studies is warranted.