SynthesisBMC cardiovascular disorders2026
Renal and cardiovascular outcomes and safety of SGLT2 inhibitors in patients aged ≥ 65 years with non-dialysis chronic kidney disease: a systematic review and meta-analysis of subgroup-level estimates derived from randomized trials.
Synthesis in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundElderly patients with non-dialysis chronic kidney disease have high cardiorenal risk. SGLT2 inhibitors are considered to potentially provide combined renal and cardiac benefits.
objectiveTo evaluate renal and cardiovascular outcomes and safety of SGLT2 inhibitors in patients aged ≥ 65 years with non-dialysis chronic kidney disease.
methodsRandomized controlled trials from database inception to 2025-7-18 were systematically searched, and trials enrolling non-dialysis chronic kidney disease and reporting a ≥ 65-year subgroup were included. The primary outcome was an adverse renal composite endpoint, and the key secondary outcome was a composite of cardiovascular death or heart failure hospitalization. Safety focused on genital mycotic infections and volume depletion/hypotension, and acute kidney injury (AKI) and diabetic ketoacidosis (DKA) were summarized descriptively. Random-effects models based on log HR or RR (REML, Hartung-Knapp) were used, pre-specified sensitivity analyses were performed, and the certainty of evidence was assessed using GRADE.
resultsThree double-blind trials including 5,831 patients aged ≥ 65 years were included. SGLT2 inhibitors reduced the risk of the adverse renal composite endpoint (HR = 0.68, 95% CI 0.52-0.89; I²=29.98%), and the risk of the composite of cardiovascular death or heart failure hospitalization (HR = 0.74, 95% CI 0.64-0.86; I²=35.53%). For safety, the risk of genital mycotic infections was increased (RR = 2.40, 95% CI 1.96-2.94; I²=23.85%), and the risk of volume depletion/hypotension was also increased (RR = 1.28, 95% CI 1.09-1.50; I²=0.00%); no signal of increased AKI was observed; DKA was very rare. GRADE rated the certainty of evidence as high for the renal outcome and moderate for the heart failure-related outcome.
conclusionIn patients aged ≥ 65 years with non-dialysis chronic kidney disease, SGLT2 inhibitors added to standard therapy achieve dual renal and cardiovascular benefits with a manageable safety profile, supporting their structured use with stratified monitoring. It is recommended that SGLT2 inhibitors be routinely included in treatment.
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