Key result
SGLT2 inhibitors reduce adverse renal events ~32% vs standard care in older CKD patients.
Why the study?
Elderly patients with non-dialysis chronic kidney disease face high cardiorenal risk, and SGLT2 inhibitors are considered to potentially provide combined renal and cardiac benefits.
Do SGLT2 inhibitors reduce adverse renal composite endpoints and cardiovascular death or heart failure hospitalization in patients aged ≥ 65 years with non-dialysis chronic kidney disease?
Meta-Analysis (n=5,831)
Do SGLT2 inhibitors reduce adverse renal composite endpoints and cardiovascular death or heart failure hospitalization in patients aged ≥ 65 years with non-dialysis chronic kidney disease?
Hazard Ratio: 0.68 (95% CI 0.52–0.89)
p-value: p=0.003
In patients aged ≥ 65 years with non-dialysis chronic kidney disease, SGLT2 inhibitors added to standard therapy achieve dual renal and cardiovascular benefits with a manageable safety profile.
Supports SGLT2 inhibitor use in elderly non-dialysis CKD; extends cardiorenal benefit evidence to this high-risk population.
Background Elderly patients with non-dialysis chronic kidney disease have high cardiorenal risk. SGLT2 inhibitors are considered to potentially provide combined renal and cardiac benefits. Objective To evaluate renal and cardiovascular outcomes and safety of SGLT2 inhibitors in patients aged ≥ 65 years with non-dialysis chronic kidney disease. Methods Randomized controlled trials from database inception to 2025-7-18 were systematically searched, and trials enrolling non-dialysis chronic kidney disease and reporting a ≥ 65-year subgroup were included. The primary outcome was an adverse renal composite endpoint, and the key secondary outcome was a composite of cardiovascular death or heart failure hospitalization. Safety focused on genital mycotic infections and volume depletion/hypotension, and acute kidney injury (AKI) and diabetic ketoacidosis (DKA) were summarized descriptively. Random-effects models based on log HR or RR (REML, Hartung–Knapp) were used, pre-specified sensitivity analyses were performed, and the certainty of evidence was assessed using GRADE. Results Three double-blind trials including 5,831 patients aged ≥ 65 years were included. SGLT2 inhibitors reduced the risk of the adverse renal composite endpoint (HR = 0.68, 95% CI 0.52–0.89; I²=29.98%), and the risk of the composite of cardiovascular death or heart failure hospitalization (HR = 0.74, 95% CI 0.64–0.86; I²=35.53%). For safety, the risk of genital mycotic infections was increased (RR = 2.40, 95% CI 1.96–2.94; I²=23.85%), and the risk of volume depletion/hypotension was also increased (RR = 1.28, 95% CI 1.09–1.50; I²=0.00%); no signal of increased AKI was observed; DKA was very rare. GRADE rated the certainty of evidence as high for the renal outcome and moderate for the heart failure-related outcome. Conclusion In patients aged ≥ 65 years with non-dialysis chronic kidney disease, SGLT2 inhibitors added to standard therapy achieve dual renal and cardiovascular benefits with a manageable safety profile, supporting their structured use with stratified monitoring. It is recommended that SGLT2 inhibitors be routinely included in treatment.
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Bao et al. (2026) conducted a meta-analysis in non-dialysis chronic kidney disease (n=5,831). SGLT2 inhibitors vs. placebo or standard therapy was evaluated on adverse renal composite endpoint (HR 0.68, 95% CI 0.52-0.89, p=0.003). SGLT2 inhibitors reduced the risk of the adverse renal composite endpoint by 32% (HR 0.68) compared to placebo or standard therapy in patients aged ≥65 years with non-dialysis chronic kidney disease.
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