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SGLT2 Inhibitors and Outcomes in Elderly Patients With Chronic Kidney Disease: A Narrative Review

Fan Zhang1, Shijie Dong1, Yifei Zhong1

  • 1Department of Nephrology, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Diabetes, Obesity & Metabolism
|August 13, 2026
PubMed
Abstract

Insights

Sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective and safe for elderly patients with chronic kidney disease (CKD). Broader adoption is recommended to improve cardiorenal outcomes in this population.

Area of Science:

  • Nephrology
  • Cardiology
  • Geriatrics

Background:

  • Sodium-glucose cotransporter 2 (SGLT2) inhibitors demonstrate significant cardiorenal protective effects in chronic kidney disease (CKD).
  • Cautious use in elderly CKD patients is noted due to safety, comorbidity, and polypharmacy concerns.

Purpose of the Study:

  • To review the efficacy, safety, and clinical implementation of SGLT2 inhibitors in elderly individuals with CKD.
  • To summarize current evidence on SGLT2 inhibitor use in older adults with CKD.

Main Methods:

  • A narrative literature search of PubMed and Embase was conducted.
  • Included English-language articles from database inception to May 2026.
  • Keywords included 'SGLT2 inhibitor', 'chronic kidney disease', 'elderly', 'aging', and 'frailty'.

Main Results:

  • SGLT2 inhibitor benefits are preserved in elderly CKD patients (≥75 years), regardless of diabetes or albuminuria.
  • SGLT2 inhibitors are generally well-tolerated, with serious adverse event rates comparable to placebo.
  • Risks of hypoglycemia, fractures, and acute kidney injury are not increased; attention needed for genital infections and volume depletion.

Conclusions:

  • Real-world SGLT2 inhibitor use in elderly CKD patients is limited by clinical inertia, cost, and access barriers.
  • Future research should target frail elderly populations and explore optimal combination therapies and long-term outcomes.
  • Evidence supports broader, equitable adoption of SGLT2 inhibitors for improved kidney and cardiovascular outcomes in elderly CKD patients.
Keywords:
chronic kidney diseaseefficacyreviewsafetysodium‐glucose cotransporter 2

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