Sodium–Glucose co-Transporter 2 Inhibitors in Severe Estimated Glomerular Filtration Rate Deterioration Across Cardiovascular-Kidney-Metabolic Conditions: A Pooled Analysis of Randomized Trials
Authors' conclusion
Severe eGFR deterioration during follow-up was associated with an increased risk of subsequent cardiovascular events and mortality. SGLT2i reduced the probability and were beneficial irrespective of severe eGFR deterioration.
Study context
- Population
- Patients with cardiovascular-kidney-metabolic conditions in EMPEROR-Preserved, EMPEROR-Reduced, EMPA-REG OUTCOME, CANVAS-R and CREDENCE
- Participants
- 26,946 patients
- Comparison
- SGLT2i vs placebo, by severe estimated glomerular filtration rate (eGFR) deterioration during follow-up
Methodological detailsplacebo-controlled, time-updated models stratified by study
- Placebo-controlled
- Time-updated models stratified by study
Pooled result
As reported in the abstract
Risk after eGFR deterioration and effect modification of SGLT2i · median follow-up 29 months
eGFR deterioration to <25 ml/min/1.73 m²
1392
5.2%
eGFR deterioration to <20 ml/min/1.73 m²
613
2.3%
SGLT2i benefit on CV outcomes and mortality maintained irrespective of eGFR deterioration
interaction-p >0.1 for all outcomes
Further pooled results
Factors associated with eGFR deterioration
- Lower baseline eGFR and higher albuminuria associated with higher risk; SGLT2i allocation protective
Permanent treatment discontinuation
- More likely with eGFR deterioration; no significant difference between SGLT2i and placebo
Original publication
Sodium–Glucose co-Transporter 2 Inhibitors in Severe Estimated Glomerular Filtration Rate Deterioration Across Cardiovascular-Kidney-Metabolic Conditions: A Pooled Analysis of Randomized Trials. Eur J Heart Fail. Published 9 November 2025. doi:10.
Summarised from the published abstract; every number is checked against it