Effects of sodium–glucose cotransporter 2 inhibitors on cardiovascular and renal outcomes in people with diabetes and advanced chronic kidney disease – published online 29/08/2024

Donna S.‑H. Lin, Jen‑Kuang Lee, Kuan‑Chih Huang, Ting‑Tse Lin, Hao‑Yun Lo

The introduction of sodium–glucose cotransporter 2 inhibitors (SGLT2i) has transformed the management of diabetes and chronic kidney disease (CKD), especially regarding cardiorenal outcomes. Although SGLT2i benefits in CKD are well established, individuals with advanced CKD (stages 4 and 5) have often been excluded from previous studies. In this issue, Lin et al (https://doi.org/10.1007/s00125-024-06257-7) show that continuing SGLT2i therapy, even as renal function declines to these advanced stages, provides significant benefits. Study participants saw reduced rates of major cardiovascular events, particularly myocardial infarctions, and lower all-cause hospital admissions, and those who maintained SGLT2i therapy also showed modestly higher haemoglobin and haematocrit levels. The authors highlight that the safety profile—covering risks of hypoglycaemia and diabetic ketoacidosis—was comparable between those who continued and those who discontinued therapy. They conclude that these findings suggest that SGLT2i can be safely continued in advanced CKD, presenting a valuable approach to improving outcomes in this high-risk group.