[Broad cardiorenal protection with SGLT2 inhibitors : Evidence, indications and clinical practice]

Sodium-glucose cotransporter‑2 (SGLT2) inhibitors were developed as glucose-lowering drugs but provide robust cardiorenal protection in large outcome trials, including in people without diabetes.

To summarise the evidence-based indication spectrum and provide practical guidance (patient selection, estimated glomerular filtration rate [eGFR] thresholds, monitoring, adverse-event management).

Across randomised trials in heart failure with reduced and preserved ejection fraction as well as chronic kidney disease (CKD), SGLT2 inhibitors consistently reduce heart failure hospitalisations and slow CKD progression. In type 2 diabetes, they lower the risk of heart failure events and, in part, atherosclerotic outcomes. Contemporary guidelines recommend SGLT2 inhibitors as foundational therapy in heart failure independent of left ventricular ejection fraction and in CKD largely independent of hemoglobin A1c (HbA1c), while considering eGFR and safety aspects. In large randomised outcome trials, SGLT2 inhibitors were shown to be safe overall, with a low and generally manageable risk of adverse events.

SGLT2 inhibitors have become key organ-protective drugs in internal medicine. Early initiation in eligible patients and structured risk mitigation (volume status, infections, ketoacidosis) are critical.