Assessment of SGLT2 inhibitors' safety and discontinuation causes in patients with advanced chronic kidney disease: insights from a real-world data analysis

To the Editor, Recent randomized trials 1 , 2 have demonstrated the renal and cardiovascular benefit of sodium-glucose cotransporter 2 inhibitors ( SGLT2i) in chronic kidney disease ( CKD) patients, irrespective of diabetes status.However, real-world data on their use in advanced CKD stages remain scarce.This study aims to assess the safety and discontinuation reasons of SGLT2i in this demographic.We conducted a retrospective analysis of 271 patients with stage 4 and non-dialysed stage 5 CKD, from January 2020 to December 2022, across five nephrology units ( CKD-REAL study) .The median initiation of SGLT2i was 356 days post-stage 4 diagnosis, predominantly with dapagliflozin ( 266 patients) and empagliflozin ( six patients) .Safety profiles and eGFR trajectories were monitored at 6 and 12 months, with a minimum followup of 6 months.