Diabetic kidney disease (DKD) occurs in approximately 20–40% of patients with type 2 diabetes mellitus.

Patients with DKD have a higher risk of cardiovascular and all-cause mortality.

Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker and antihyperglycemic drugs form the mainstay of DKD management and aim to restrict progression to more severe stages of DKD.

The sodium-glucose cotransporter 2 inhibitors (SGLT2i) control hyperglycemia by blocking renal glucose reabsorption in addition to preventing inflammation, thereby improving endothelial function and reducing oxidative stress, and hence are emerging as an important addition to the therapeutic armamentarium.

The EMPA-REG OUTCOME, DECLARE TIMI 58, and CANVAS trials demonstrated the renoprotective effects of SGLT2i, which were further confirmed by the CREDENCE study and DELIGHT study. In addition, a meta-analysis demonstrated a reduced risk of dialysis, transplantation, or death due to kidney disease and 45% risk reduction in worsening of renal function, end-stage renal disease, or renal death with SGLT2i, irrespective of baseline estimated glomerular filtration rate level. Thus, there is emerging evidence that SGLT2i may be used to curb mortality and improve quality of life in patients with DKD, although clinicians need to effectively select candidates for SGLT2i therapy.

In this consensus statement, we have qualitatively synthesized evidence demonstrating the renal effects of SGLT2i and have proposed recommendations for optimal use of SGLT2i to effectively manage and delay progression of DKD.