SGLT-2 Inhibitors in Patients with Stage 5 CKD?

Randomized clinical trials have shown that sodium–glucose cotransporter-2 (SGLT-2) inhibitors slow progression of chronic kidney disease (CKD) and need for dialysis (e.g., NEJM JW Gen Med Dec 1 2022 and N Engl J Med 2023; 388:117). Although various guidelines suggest initiating SGLT-2 inhibitors in patients with estimated glomerular filtration rates (eGFR) of ≥20 mL/minute/1.73 m², SGLT-2 inhibitors have not been evaluated in patients with stage 5 CKD (CKD 5; eGFR, ≤15 mL/minute/1.73 m²). Investigators in Taiwan retrospectively assessed 5 years of outcome data for nearly 48,000 patients with type 2 diabetes and CKD 5 — half of patients had newly initiated SGLT-2 inhibitors, and half were not taking these drugs.

Compared with SGLT-2 inhibitor…