SGLT2
Inhibitors and Outcomes in Elderly Patients With Chronic Kidney Disease: A Narrative Review
Fan Zhang, Shijie Dong, Yifei Zhong, Xianwen Zhang ABSTRACT
Background
Sodium‐glucose cotransporter 2 (SGLT2) inhibitors have emerged as a cornerstone therapy for chronic kidney disease (CKD) because of their robust cardiorenal protective effects. However, their use in elderly patients remains cautious due to concerns regarding safety, comorbidities and polypharmacy. This review summarises current evidence regarding the efficacy, safety and clinical implementation of SGLT2 inhibitors in elderly individuals with CKD.
Methods
We conducted a narrative literature search of PubMed and Embase for English‐language articles published from database inception to May 2026 using combinations of the terms ‘SGLT2 inhibitor’, ‘sodium‐glucose cotransporter 2 inhibitor’, ‘chronic kidney disease’, ‘elderly’, ‘older adults’, ‘aging’ and ‘frailty’. We prioritised randomised controlled trials, meta‐analyses, guideline statements and large real‐world observational studies reporting kidney, cardiovascular, safety or implementation outcomes relevant to elderly patients with CKD.
Results
Subgroup analyses and real‐world studies consistently indicate that these benefits are preserved in elderly patients, including those aged ≥ 75 years, irrespective of diabetes status or baseline albuminuria. Safety analyses suggest that SGLT2 inhibitors are generally well tolerated in elderly CKD patients. While genital infections, volume depletion and rare cases of euglycemic diabetic ketoacidosis require attention, overall rates of serious adverse events are comparable to placebo and risks of hypoglycemia, fractures and acute kidney injury are not increased.
Conclusion
Despite strong guideline recommendations, real‐world utilisation of SGLT2 inhibitors in elderly patients remains limited because of clinical inertia, cost barriers and disparities in healthcare access. Future research should focus on frail and very elderly populations, optimal combination therapies and long‐term functional outcomes. Overall, current evidence supports the broader and equitable adoption of SGLT2 inhibitors to improve kidney and cardiovascular outcomes in elderly patients with CKD.