ArticleFrontiers in cardiovascular medicine2026
Long-term efficacy and renal safety of SGLT2 inhibitors in patients with heart failure and advanced chronic kidney disease (stage 4): a propensity score-matched retrospective cohort study.
Article in Frontiers in cardiovascular medicine, 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
Objective: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are a cornerstone of heart failure (HF) therapy; however, landmark trials systematically excluded patients with severe renal impairment. Consequently, prescribing SGLT2i for HF patients with advanced chronic kidney disease (CKD stage 4) remains a clinical "blind spot" due to fears of acute kidney injury. This study aimed to evaluate the long-term efficacy and renal safety of SGLT2i in this vulnerable, real-world population. Methods: This single-center, retrospective observational cohort study evaluated HF patients with a baseline estimated glomerular filtration rate (eGFR) of 15-29 mL/min/1.73 m Results: Following PSM, the final analysis cohort comprised 320 balanced patients (160 in the SGLT2i group and 160 in the control group), with a median baseline eGFR of 22.4 mL/min/1.73 m Conclusions: In high-risk, real-world HF patients complicated by advanced CKD (Stage 4), SGLT2i therapy appears to be associated with substantial cardiovascular benefits and may attenuate long-term renal function decline. These findings suggest that severe renal impairment should not instinctively preclude the utilization of this life-saving therapy.
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