Real-world study highlights potential benefits and risks
Adults aged 80 years and older with chronic kidney disease may still benefit from sodium-glucose cotransporter 2, or SGLT2, inhibitors, according to new research scheduled for presentation at ASN Kidney Week 2026. The analysis also points to potentially important safety trade-offs in this older population.
Investigators examined electronic health-record data from 10,076 adults aged 80 or older with chronic kidney disease. Over two years of follow-up, starting an SGLT2 inhibitor was associated with an 18% reduction in all-cause mortality and a 22% reduction in major adverse kidney events.
The findings matter because very old adults are often underrepresented in large randomized clinical trials. Multimorbidity and frailty can make it harder for such patients to be included in conventional studies, leaving clinicians with less direct evidence when considering treatments for people in this age group.
Benefits were not uniform across outcomes
The analysis found no significant overall effect on major adverse cardiovascular events. At the same time, the researchers reported higher risks of particular cardiac events, including heart attacks and acute heart failure, as well as a higher risk of acute kidney injury among people receiving SGLT2 inhibitors.
That combination of findings argues against treating the results as a simple endorsement or rejection of the drug class for the oldest patients. The mortality and kidney-event associations are notable, but the reported adverse-event signals mean treatment decisions must account for an individual patient’s health status and risks.
SGLT2 inhibitors are medicines whose mechanism involves sodium-glucose transport. In this research, they were evaluated specifically in adults with chronic kidney disease who were at least 80 years old, rather than as a broadly interchangeable treatment for every older patient.
A gap in the evidence base
Corresponding author Bernhard M. W. Schmidt of Hannover Medical School said the work addresses a blind spot in medical literature by using real-world data from a group that has historically been underrepresented or excluded from major randomized trials.
Electronic health records can make it possible to study outcomes across a large clinical population. But an observational analysis links treatment initiation with later outcomes; it does not, on its own, establish that the treatment caused each observed difference. The study’s results should therefore be interpreted as evidence that can inform clinical assessment, not as a substitute for individualized care.
The researchers’ results also underscore why older adults should not be assumed to have no potential to benefit from newer therapies solely because of age. The population studied was 80 years and older, and the associations with lower mortality and fewer major kidney events were observed during the two-year follow-up period.
Monitoring remains central
Schmidt said that even the oldest and most vulnerable patients with chronic kidney disease can derive substantial benefits from SGLT2 inhibitor treatment, while cautioning that the medications may not be without risk in this demographic. He called for a careful, individualized risk-benefit assessment and close clinical monitoring.
For clinicians and patients, the key message is not that age eliminates the relevance of treatment, nor that it removes the need for caution. The study presents both possible benefits and potential harms: lower all-cause mortality and fewer major adverse kidney events on one side, and increased risks of specific cardiac events and acute kidney injury on the other.
Further assessment of the findings will be important as the research moves beyond its conference presentation. For now, the data add a large real-world analysis to a clinical question that has been difficult to answer for the oldest adults with chronic kidney disease.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
