Kidney Week

Abstract: SA-PO1146

Discontinuation of SGLT2 Inhibitors in Advanced CKD: An Inverse Probability of Treatment Weighting Analysis

Session Information

• CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
  November 08, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Szeto, Cheuk-Chun, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong

Cheuk-Chun Szeto, MD

• Ng, Jack Kit-Chung, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong

Jack Kit-Chung Ng, MBChB

Background

Sodium-glucose co-transporter 2 inhibitors (SGLT2i) slow the progression of chronic kidney disease (CKD). However, the evidence to support the continuation of SGLT2i when eGFR fell below 20 ml/min/1.73 m²is limited.

Methods

Between 2015 and 2021, we identified 1011 CKD patients who received SGLT2i for at least 3 months and had eGFR progressed to ≤20 ml/min/1.73m²; 585 were continued with SGLT2i (Continuation group), and 426 had SGLT2i stopped (Discontinuation group). The primary outcome was dialysis-free survival. Inverse probability of treatment weighting (IPTW) was applied to minimize baseline differences between the two groups.

Results

The median follow up was 14.3 months (IQR 8.7 – 21.8 months). The IPTW-adjusted two-year dialysis-free survival rates of the Discontinuation and Continuation groups were 41.7% and 58.9%, respectively (p < 0.0001). With the multi-variable Cox regression model to adjust for confounding factors, the Continuation group had a 39.9% (95%CI, 24.1% to 52.5%) reduction in risk of progression to dialysis or death. The IPTW-adjusted two-year patient survival rates of the Discontinuation and Continuation groups were 40.6% and 71.7%, respectively (p < 0.0001). With multi-variable Cox regression model, Continuation group had a 46.8% (95%CI, 29.8% to 59.7%) reduction in risk of death. The result remained similar when a propensity score-matched nested cohort was used for analysis.

Conclusion

In CKD patients who received SGLT2i therapy, continuation of the SGLT2i therapy after the eGFR fell below 20 ml/min/1.73m² was associated with a better dialysis-free survival and patient survival than discontinuation of SGLT2i. Our result support the recommendation of continuation with SGLT2i in this setting.

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.2025ct9f8j8n