Cardio-Vasculo-Renal Benefits of SGLT2 Inhibitors in Heart Failure: A Retrospective Study from a Lower-Resource Tertiary Center

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic heart failure (n=240). Intervention: SGLT2 inhibitors vs. No SGLT2 inhibitor treatment. Primary outcome: Composite of cardiovascular death, first hospitalization for heart failure, or a major renal event (≥40% sustained decline in eGFR or initiation of kidney replacement therapy) (HR 0.70, 95% CI 0.50–0.98, p=0.006).

Olivia-Maria Bodea; Gabriel Florin Răzvan Mogoș; Nilima Rajpal Kundnani; Abhinav Sharma; Ovidiu Adam; Daniel Marius Duda-Seiman; Dana Emilia Velimirovici; Marioara Nicula-Neagu; Ovidiu Horea Bedreag; Simona Dragan

doi:10.3390/medicina62020256

January 26, 2026MedicinaOpen Access

Cardio-Vasculo-Renal Benefits of SGLT2 Inhibitors in Heart Failure: A Retrospective Study from a Lower-Resource Tertiary Center

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Key result

SGLT2 inhibitors linked to ~30% lower risk of composite cardio-vasculo-renal events.

HR 0.70
95% CI 0.50–0.98
P=0.006
n=240

Figures

Why the study?

Although SGLT2 inhibitors demonstrate cardiovascular and renal benefits in trials, real-world data in lower-resource settings remain limited.

Does SGLT2 inhibitor therapy reduce the composite of cardiovascular death, heart failure hospitalization, or major renal events in adults with chronic heart failure and LVEF ≤ 45%?

Study Design

Type

Cohort (n=240)

Multicenter

No

Structured PICO

Does SGLT2 inhibitor therapy reduce the composite of cardiovascular death, heart failure hospitalization, or major renal events in adults with chronic heart failure and LVEF ≤ 45%?

P

Population

240 adults with chronic heart failure and LVEF ≤ 45% managed at a tertiary center in Romania, followed for a median of 24 months.

E

Exposure

SGLT2 inhibitors (predominantly empagliflozin [55%], dapagliflozin [42%], canagliflozin [3%]) modeled as a time-dependent variable, added to standard guideline-directed medical therapy. Median duration of exposure was 22 months.

C

Comparator

No SGLT2 inhibitor therapy; both groups broadly received background guideline-directed medical therapy including RAAS inhibitors/ARNI, beta-blockers, and mineralocorticoid receptor antagonists.

O

Outcome

Composite of the first occurrence of cardiovascular death, first hospitalization for heart failure, or a major renal event (≥40% sustained decline in eGFR or initiation of kidney replacement therapy).composite

Main Result

Hazard Ratio: 0.7 (95% CI 0.5–0.98)

Absolute Event Rate: 24.1% vs 35%

p-value: p=0.006

In a real-world, lower-resource setting, SGLT2 inhibitor use was associated with a lower risk of cardio-renal events and attenuated kidney function decline in patients with chronic heart failure and reduced ejection fraction.

Limitations

Retrospective observational design introducing potential for residual confounding and confounding by indication.
Single-center cohort which may limit generalizability.
Reliance on correct specification of treatment timing with time-dependent exposure modeling assuming no unmeasured time-varying confounders.
Retrospective observational design
Residual confounding risk
Confounding by indication
Single-center setting

Implication

Should not yet change practice in HFrEF; hypothesis-generating and leaves open need for RCTs in lower-resource settings.

Abstract

Background and Objectives: Heart failure frequently coexists with CKD, compounding prognosis via cardio-renal interplay. Sodium glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular and renal benefits in randomized trials, but data remain limited in real-world lower-resource settings. Materials and Methods: We conducted a retrospective single-center cohort study at a tertiary university hospital in western Romania, including adults with chronic HF and LVEF ≤ 45%, monitored between 2021–2024. Patients were stratified based on receipt of SGLT2 inhibitors. The primary endpoint was a composite of cardiovascular death, HF hospitalization, or ≥40% sustained decline in eGFR/initiation of KRT. Annual eGFR slope was analyzed to assess renal trajectory. Results: Among 240 patients, treatment with SGLT2 inhibitors was associated with a lower risk of the composite cardio-vasculo-renal endpoint compared with no treatment (adjusted HR 0.70, 95% CI 0.50–0.98). The reduction was primarily driven by fewer heart failure hospitalizations. Decline in kidney function was slower among SGLT2 inhibitor-treated patients in longitudinal mixed-effects analyses. Conclusions: In this retrospective cohort, SGLT2 inhibitor use was associated with fewer cardio-renal events and a slower decline in kidney function. Given the observational design and residual confounding risk, these findings should be considered hypothesis-generating but provide implementation-relevant signals supporting further prospective evaluation.

Discussion

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Cite This Study

Bodea et al. (2026) conducted a cohort in Chronic heart failure (n=240). SGLT2 inhibitors vs. No SGLT2 inhibitor treatment was evaluated on Composite of cardiovascular death, first hospitalization for heart failure, or a major renal event (≥40% sustained decline in eGFR or initiation of kidney replacement therapy) (HR 0.70, 95% CI 0.50–0.98, p=0.006). SGLT2 inhibitor exposure was associated with a significantly lower risk of the composite cardio-vasculo-renal endpoint compared with no treatment (adjusted HR 0.70).

synapsesocial.com/papers/6a0e1898370e1ecbafd08a32 https://doi.org/10.3390/medicina62020256