SGLT2 Inhibitors Linked to Lower Mortality in Adults 80 and Older With CKD, Alongside Cardiac and Kidney Risks

A team of researchers has turned to the electronic health records of 10,076 adults aged 80 or older with chronic kidney disease to ask a question that clinical trials have largely left unanswered: what happens when the very oldest patients start taking an SGLT2 inhibitor? The findings are set to be presented at ASN Kidney Week 2026, which runs October 22 to 25 in Denver.

SGLT2 inhibitors, short for sodium-glucose cotransporter 2 inhibitors, are a class of medication. In this analysis, the investigators followed patients over two years after therapy began and compared outcomes. Starting an SGLT2 inhibitor was linked to an 18 percent reduction in all-cause mortality. It was also linked to a 22 percent reduction in major adverse kidney events.

The picture was less tidy on the heart. Across the group, the researchers found no significant effect on major adverse cardiovascular events overall. But when they looked at particular cardiac events, the medications were associated with higher risks of heart attacks and of acute heart failure. They were also associated with a higher risk of acute kidney injury, which sits awkwardly beside the reduction in major kidney events.

The corresponding author is Bernhard M. W. Schmidt, MD, SM, of the Department of Nephrology and Hypertension at Hannover Medical School in Germany. He points to why the question has gone unanswered. Very elderly people, he said, have historically been underrepresented in large randomized controlled trials, or systematically excluded from them, because of multimorbidity and frailty. Real-world data, in his view, addresses a crucial blind spot in the medical literature.

Schmidt's reading of the results is two-sided. Even the oldest and most vulnerable patients with CKD can derive substantial benefit from SGLT2 inhibitor treatment, he said, but the drugs may not be without risk in this age group. He argued that these patients need a careful, individualized assessment of risks and benefits, along with close clinical monitoring.

The study is titled "Extending Benefit to the Oldest Old: Efficacy of SGLT2 Inhibitors in Older Adults with CKD." Because it draws on health records rather than a randomized trial, it shows association, not proof of cause. The authors' own call for individualized assessment reflects that limit.

Kidney Week, which organizers describe as the premier nephrology meeting, expects more than 12,000 kidney professionals. Early programs began October 21, with the Annual Meeting following October 22 to 25. What to watch is whether the cardiac and acute kidney injury signals hold up in further work, and how clinicians weigh them against the mortality and kidney findings for patients in their ninth decade.