Continuation of sodium-glucose cotransporter-2 inhibitors in advanced chronic kidney disease: a retrospective study with inverse probability of treatment weighting analysis

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ID: 324251
2026
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Abstract
Abstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i) slow the progression of chronic kidney disease (CKD). However, the evidence to support the continuation of SGLT2i when eGFR fell below 20 ml/min/1.73 m2is limited. Methods Between 2015 and 2021, we identified 1011 CKD patients who received SGLT2i for at least 3 months and had eGFR progressed to ≤20 ml/min/1.73m2; 585 were continued with SGLT2i (Continuation group), and 426 had SGLT2i stopped (Discontinuation group). Inverse probability of treatment weighting (IPTW) was applied to minimize baseline differences between the two groups. The primary outcome was dialysis-free survival. Results The median follow up was 14.3 months (IQR 8.7–21.8 months). The IPTW-adjusted two-year dialysis-free survival rates of the Discontinuation and Continuation groups were 41.7% and 58.9%, respectively (weighted log rank test, P < 0.0001). Continuation of SGLT2i was associated with 39.9% reduction in risk of progression to dialysis or death (weighted hazard ratio 0.601, 95% CI 0.241–0.525). The IPTW-adjusted two-year patient survival rates of the Discontinuation and Continuation groups were 40.6% and 71.7%, respectively (P < 0.0001). With multi-variable Cox regression model, Continuation group had a 46.8% (95%CI, 29.8% to 59.7%) reduction in risk of death. The result remained similar when a propensity score-matched nested cohort was used for analysis. Conclusion In CKD patients who received SGLT2i therapy, continuation of the SGLT2i therapy after the eGFR fell below 20 ml/min/1.73m2 was associated with a higher dialysis-free survival and patient survival than discontinuation of SGLT2i. Our result suggests the practice of continuation with SGLT2i in this setting.
Reference Key
openalex_W7201833410 Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Jack Kit-Chung Ng, Elaine Yee-Kwan Chow, Winston Wing‐Shing Fung, Gordon Chun‐Kau Chan, Kai-Ming CHOWT, Cheuk‐Chun Szeto
Journal clinical kidney journal
Year 2026
DOI
10.1093/ckj/sfag260
URL
https://doi.org/10.1093/ckj/sfag260
Keywords Keywords not found

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