Are SGLT-2 Inhibitors Beneficial and Safe in Patients with Advanced CKD?

Whether sodium–glucose cotransporter-2 (SGLT-2) inhibitors benefit patients with advanced chronic kidney disease (CKD) is uncertain, as relatively few such patients have been included in SGLT-2 studies. To focus on safety and efficacy in this subgroup, researchers conducted a meta-analysis of 10 placebo-controlled trials. Overall, the studies involved 5000 patients with estimated glomerular filtration rates (eGFR) of <30 mL/minute/1.73 m² and 33,000 patients with eGFRs of ≥30 mL/minute/1.73 m². In the low-eGFR group, most patients had stage 4 CKD (mean eGFR, 25 mL/minute). Mean follow-up was 19 months.

Key findings were as follows:

• In the low-eGFR group, significantly fewer SGLT-2 recipients than placebo recipients developed the composite kid…