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Sodium glucose co\u2010transporter 2 inhibitors (\n SGLT2i<\/jats:styled-content>\n ) reduce albuminuria and improve kidney outcomes in patients with albuminuric chronic kidney disease (\n CKD<\/jats:styled-content>\n ). Patients with low\u2010 or without albuminuria have been underrepresented in randomised clinical trials (\n RCTs<\/jats:styled-content>\n ), and the effects of\n SGLT2i<\/jats:styled-content>\n on cardiovascular and kidney outcomes across the full range of albuminuria require further investigation.\n <\/jats:p>\n <\/jats:sec>\n \n Aims<\/jats:title>\n \n To study the effects of\n SGLT2i<\/jats:styled-content>\n on kidney and cardiovascular outcomes across albuminuria levels in populations with different cardiovascular\u2013kidney\u2013metabolic (\n CKM<\/jats:styled-content>\n ) risk.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n Individual\u2010patient data pooled analysis of\n RCTs<\/jats:styled-content>\n across the\n CKM<\/jats:styled-content>\n spectrum. Outcomes were studied across urinary albumin\u2010to\u2010creatinine ratio (\n UACR<\/jats:styled-content>\n ) both as categorical and continuous variables using survival and mixed effects models.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of\u200926\u2009750 patients were included. The median (pct\n 25\u201075<\/jats:sub>\n ) baseline\n UACR<\/jats:styled-content>\n was 28 (8\u2013240) mg\/g: 13\u2009669 (51.1%) had\n UACR<\/jats:styled-content>\n <30\u2009mg\/g, 6904 (25.8%)\n UACR<\/jats:styled-content>\n 30\u2013300\u2009mg\/g, and 6177 (23.1%)\n UACR<\/jats:styled-content>\n >300\u2009mg\/g. Compared to patients with lower\n UACR<\/jats:styled-content>\n , those with higher\n UACR<\/jats:styled-content>\n were younger, with a more frequent history of hypertension, diabetes, and obesity, and lower\n eGFR<\/jats:styled-content>\n .\n UACR<\/jats:styled-content>\n was linearly associated with kidney and cardiovascular outcomes as well as mortality. Compared to placebo,\n SGLT2i<\/jats:styled-content>\n reduced the risk of kidney events,\n HF<\/jats:styled-content>\n hospitalisations, atherothrombotic events, cardiovascular and all\u2010cause mortality across the full\n UACR<\/jats:styled-content>\n spectrum (Pinteraction >0.1 for all outcomes). Compared to placebo,\n SGLT2i<\/jats:styled-content>\n reduced albuminuria levels by 13%, on average:\n gMratio<\/jats:styled-content>\n 0.87, 95%\n CI<\/jats:styled-content>\n 0.85\u20130.88,\n p<\/jats:italic>\n \u2009<\u20090.001.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Higher albuminuria was associated with an increased risk of cardiovascular and kidney outcomes.\n SGLT2i<\/jats:styled-content>\n improved cardiovascular and kidney outcomes across the full range of albuminuria, including normo\u2010albuminuria.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/dom.70289","type":"journal-article","created":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T09:25:57Z","timestamp":1762766757000},"page":"1105-1115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Effects of\n SGLT2<\/scp>\n inhibitors across the spectrum of albuminuria in cardiovascular\u2013kidney\u2013metabolic conditions: A pooled analysis of randomised trials"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2304-6138","authenticated-orcid":false,"given":"Jo\u00e3o Pedro","family":"Ferreira","sequence":"first","affiliation":[{"name":"RISE\u2010Health, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina Universidade do Porto Porto Portugal"},{"name":"Universit\u00e9 de Lorraine, INSERM, Centre d'Investigations Cliniques, CHRU de Nancy, Inserm and INI\u2010CRCT (Cardiovascular and Renal Clinical Trialists) F\u2010CRIN Network Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro","family":"Marques","sequence":"additional","affiliation":[{"name":"RISE\u2010Health, Departamento de Cirurgia e Fisiologia, Faculdade de Medicina Universidade do Porto Porto Portugal"},{"name":"Servi\u00e7o de Medicina Interna Unidade Local de Sa\u00fade S\u00e3o Jo\u00e3o Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Department of Cardiology (CVK) of German Heart Center Charit\u00e9, German Centre for Cardiovascular Research (DZHK) partner site Berlin Charit\u00e9 Universit\u00e4tsmedizin Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7683-4720","authenticated-orcid":false,"given":"Javed","family":"Butler","sequence":"additional","affiliation":[{"name":"Baylor Scott and White Research Institute, Dallas, TX and University of Mississippi Jackson Mississippi USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos","family":"Filippatos","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens School of Medicine Athens University Hospital Attikon Athens 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