Impact of Sodium-Glucose Cotransporter-2 Inhibitors on Cardiovascular Function and Residual Kidney Function in...

Chronic kidney disease (CKD) patients are at high risk for cardiovascular morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown promising benefits in the management of cardiovascular and renal outcomes. While SGLT2i are not approved for use in patients undergoing haemodialysis (HD), emerging evidence suggests that SGLT2i may offer cardioprotective and nephroprotective effects in patients on kidney replacement therapy. This study aims to evaluate the effects of SGLT2i on both cardiovascular status using transthoracic echocardiography and residual kidney function in HD patients over a three-month period. This prospective single-arm intervention study enrolled 40 maintenance HD patients from a tertiary care centre. Participants received empagliflozin 10 mg once daily for 12 weeks alongside standard HD therapy. Comprehensive assessments were performed at baseline and study termination, including (1) transthoracic echocardiography with measurements of left ventricular filling pressures (E/e' ratio and left ventricular end-diastolic pressure (LVEDP)), chamber dimensions, and systolic/diastolic function according to the American Society of Echocardiography guidelines; (2) biochemical analyses of renal function-estimated glomerular filtration rate (eGFR), inflammation-high-sensitivity C-reactive protein (hs-CRP), and metabolic parameters; and (3) clinical evaluation of functional status (New York Heart Association classification) and haemodynamic parameters. Following 12 weeks of SGLT2i therapy, participants demonstrated significant improvements across multiple cardiorenal parameters. Echocardiographic changes included reduced left ventricular filling pressures (E/e': -17.1%; LVEDP: -3.2 mmHg; both: p < 0.001) and favourable cardiac remodelling (left atrial volume index: -11.8%; left ventricular end-diastolic diameter: -4.4%; both: p < 0.001) with preserved systolic function. Systemic benefits encompassed blood pressure reduction (-10/-4 mmHg, p < 0.01), decreased inflammation (hs-CRP: -38%; p = 0.005), and improved albuminuria (albumin-to-creatinine ratio: -80 mg/g; p = 0.022). Functional capacity improved in 30% of patients (p = 0.008), with modest renal benefit (eGFR: +0.8 mL/min/1.73m²; p = 0.087). We conclude that SGLT2i therapy in HD patients was associated with improved diastolic function, reduced inflammation, and promoted reverse cardiac remodelling without compromising systolic function, while demonstrating an acceptable safety profile. These findings support further randomised trials to confirm cardiovascular and residual renal benefits in end-stage kidney disease.