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Real-world effectiveness of SGLT2 inhibitors in patients with HF and ESKD: a multicenter cohort study

Jheng-Yan Wu1,2, Kuan-Jui Tseng3, Chia-Li Kao4

  • 1Department of Nutrition, Chi Mei Medical Center, Tainan, Taiwan.

Frontiers in Cardiovascular Medicine
|February 2, 2026
PubMed

Insights

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) significantly reduced hospitalization, mortality, and pulmonary edema in heart failure and end-stage kidney disease patients. This suggests SGLT2i may be a valuable treatment for this high-risk population.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Patients with heart failure (HF) and end-stage kidney disease (ESKD) have limited therapeutic options and high mortality rates.
  • Sodium-glucose cotransporter-2 inhibitors (SGLT2i) show cardiovascular and renal benefits, but their impact in HF and ESKD is understudied due to trial exclusions.

Purpose of the Study:

  • To evaluate the effectiveness of SGLT2i in reducing one-year clinical outcomes in patients with HF and ESKD.
  • Key outcomes included all-cause hospitalization, all-cause mortality, and acute pulmonary edema.

Main Methods:

  • A retrospective cohort study utilized the TriNetX network, analyzing patients with HF and ESKD from 2016-2025.
  • Propensity score matching (PSM) balanced baseline characteristics between SGLT2i users and non-users.
  • Cox proportional hazard models assessed the primary composite outcome and secondary outcomes, with sensitivity analyses performed.

Main Results:

  • The study analyzed 10,032 patients post-PSM.
  • SGLT2i use was linked to a significantly lower risk of the primary composite outcome (all-cause hospitalization, mortality, acute pulmonary edema) at one year (HR 0.80, 95% CI 0.76-0.84).
  • Consistent benefits were observed across various HF phenotypes, comorbidities, and SGLT2i types.

Conclusions:

  • SGLT2i are significantly associated with reduced one-year hospitalization, mortality, and acute pulmonary edema in patients with HF and ESKD.
  • These findings suggest a potential therapeutic role for SGLT2i in this vulnerable population.
  • Further clinical trials are warranted to confirm the efficacy and safety of SGLT2i in HF and ESKD patients.
Abstract

Keywords:
end-stage kidney diseaseheart failuremajor adverse cardiovascular eventsmajor adverse kidney eventssodium-glucose cotransporter-2 inhibitors

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