SGLT-2 inhibitors associated with improved outcomes in stage 5 CKD patients

Patients with type 2 diabetes and stage 5 chronic kidney disease (CKD) had lower risk of progressing to dialysis or having a cardiovascular event if they took sodium-glucose cotransporter-2 (SGLT-2) inhibitors, a study found.

Patients with type 2 diabetes and stage 5 chronic kidney disease (CKD) had better outcomes with sodium-glucose cotransporter-2 (SGLT-2) inhibitors, a Taiwanese study found.

The target trial emulation study used Taiwan's National Health Insurance Research Database to identify 23,854 patients who took SGLT-2 inhibitors and 23,892 who did not. All had type 2 diabetes and stage 5 CKD and data available from May 2016 through October 2021. Results were published by Annals of Internal Medicine on April 30.

In an intention-to-treat analysis, patients taking SGLT-2 inhibitors had lower risk of dialysis initiation (hazard ratio [HR], 0.34; 95% CI, 0.27 to 0.43), hospitalization for heart failure (HR, 0.80; 95% CI, 0.73 to 0.86), acute myocardial infarction (HR, 0.61; 95% CI, 0.52 to 0.73), diabetic ketoacidosis (HR, 0.78; 95% CI, 0.71 to 0.85), and acute kidney injury (HR, 0.80; 95% CI, 0.70 to 0.90). The two groups showed no difference in all-cause mortality (HR, 1.11; 95% CI, 0.99 to 1.24).

The results indicate that SGLT-2 inhibitors may be beneficial for diabetes patients even if they have estimated glomerular filtration rates less than 15 mL/min/1.73 m2, the study authors observed. "To our knowledge, our study is the first to suggest that the use of SGLT2 [inhibitors] in stage 5 CKD may reduce the risk for dialysis," they wrote. "Sodium–glucose cotransporter-2 inhibitors are likely to be a cornerstone in managing patients at different stages of CKD to reduce the risk for dialysis and cardiovascular disease." The authors called for randomized trials to confirm their results.