In a retrospective study, patients with severe chronic kidney disease who received SGLT-2 inhibitors had better outcomes than patients who did not.

Randomised clinical trials have shown that sodium-glucose cotransporter-2 (SGLT-2) inhibitors slow progression of chronic kidney disease (CKD) and need for dialysis (e.g. NEJM JW Gen Med Dec 1 2022 and N Engl J Med 2023; 388: 117-127). Although various guidelines suggest initiating SGLT-2 inhibitors in patients with estimated glomerular filtration rates (eGFR) of 20mL/min/1.73m² or higher, SGLT-2 inhibitors have not been evaluated in patients with stage 5 CKD (CKD 5; eGFR, 15mL/min/1.73m² or lower). Investigators in Taiwan retrospectively assessed five years of outcome data for nearly 48,000 patients with type 2 diabetes and CKD 5 – half of patients had newly initiated SGLT-2 inhibitors, and half were not taking these drugs.

Compared with SGLT-2 inhibitor nonusers, users had significantly lower risk for dialysis (adjusted hazard ratio [aHR], 0.34) and fewer hospitalisations for heart failure, acute myocardial infarction, diabetic ketoacidosis and acute kidney injury (aHRs, 0.6 to 0.8). All-cause mortality was similar in the two groups.

Comment: This study was retrospective, with inherent risks for residual confounding, so the authors stop short of recommending that patients with CKD 5 routinely be prescribed SGLT-2 inhibitors. Nevertheless, this first analysis in patients with severe renal disease shows that SGLT-2 inhibitors probably are associated with outcome improvements – including less progression to dialysis. It might pave the way for considering these medications in a broader group of patients with CKD.

Daniel D. Dressler, MD, MSc, MHM, FACP, Professor of Medicine, Emory University School of Medicine, Atlanta, USA.

Yen F-S, et al. Sodium–glucose cotransporter-2 inhibitors and the risk for dialysis and cardiovascular disease in patients with stage 5 chronic kidney disease. Ann Intern Med 2024; 177: 693-700.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.