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SGLT2 Inhibitors and Liver Cirrhosis: Hype or Hope?
Olga Brusnic1, Danusia Maria Onisor1, Adrian Boicean2
1Department of Internal Medicine VII, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Gheorghe Marinescu Street No. 38, 540136 Targu Mures, Romania.
Life (Basel, Switzerland)
|December 30, 2025
Summary
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) show promise for managing ascites in liver cirrhosis by increasing sodium excretion. Careful monitoring is crucial due to potential side effects, especially in decompensated patients.
Area of Science:
- Hepatology
- Nephrology
- Endocrinology
Background:
- Liver cirrhosis causes fluid retention and portal hypertension, worsening prognosis.
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) offer cardio-renal benefits and induce natriuresis.
- Interest is growing in SGLT2i as an adjunct therapy for ascites in cirrhosis.
Purpose of the Study:
- To review the efficacy and safety of SGLT2i in managing ascites in liver cirrhosis.
- To explore the mechanistic basis for SGLT2i's effects in cirrhotic patients.
- To assess the potential of SGLT2i in reducing hepatic decompensation and hepatocellular carcinoma risk.
Main Methods:
- Systematic review of observational cohorts and case series.
- Analysis of studies investigating SGLT2i in patients with liver cirrhosis and ascites.
- Evaluation of reported efficacy, safety, and adverse events.
Main Results:
- SGLT2i, added to diuretics, increased natriuresis and reduced ascites burden.
- Improvements observed in weight, aminotransferases, and paracentesis requirements.
- Potential reduction in hepatic decompensation and hepatocellular carcinoma risk noted.
Conclusions:
- SGLT2i show cautious optimism as an adjunct for selected cirrhotic patients with ascites.
- Careful patient selection, titration, and monitoring are essential due to safety concerns.
- Further large-scale trials are needed to confirm hepatic benefits and optimal use.
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