Kidney Week

Abstract: SA-PO0439

SGLT2 Inhibitors in Older Patients: Early Cardiorenal, Functional, and Biological Changes in Clinical Practice

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Merolla, Aurora, Universita Vita Salute San Raffaele, Milan, Lombardy, Italy

Aurora Merolla, MD

• Uruci, Sindi, Universita Vita Salute San Raffaele, Milan, Lombardy, Italy

Sindi Uruci, MD

• Rela, Elena, Universita Vita Salute San Raffaele, Milan, Lombardy, Italy

Elena Rela, MD

• Tanzarella, Elena, Universita Vita Salute San Raffaele, Milan, Lombardy, Italy

Elena Tanzarella, MD

• Guerra, Federica, IRCCS San Raffaele Scientific Institute, Milan, Italy

Federica Guerra, MSc

• Barrasso, Cristina, IRCCS San Raffaele Scientific Institute, Milan, Italy

Cristina Barrasso, DrMed

• Zagato, Laura, IRCCS San Raffaele Scientific Institute, Milan, Italy

Laura Zagato

• El Boustani, Maguie, IRCCS San Raffaele Scientific Institute, Milan, Italy

Maguie El Boustani, PhD

• Sciarrone Alibrandi, Maria Teresa, IRCCS San Raffaele Scientific Institute, Milan, Italy

Maria Teresa Sciarrone Alibrandi

• Simonini, Marco, IRCCS San Raffaele Scientific Institute, Milan, Italy

Marco Simonini, MD

• Maiucchi, Paola, IRCCS San Raffaele Scientific Institute, Milan, Italy

Paola Maiucchi, RN

• Freuli, Francesca, Universita Vita Salute San Raffaele, Milan, Lombardy, Italy

Francesca Freuli

• Cugnata, Federica, IRCCS San Raffaele Scientific Institute, Milan, Italy

Federica Cugnata

• Di Serio, Clelia, Universita Vita Salute San Raffaele, Milan, Lombardy, Italy

Clelia Di Serio

• Rovere Querini, Patrizia, IRCCS San Raffaele Scientific Institute, Milan, Italy

Patrizia Rovere Querini, MD, PhD

• Lanzani, Chiara, IRCCS San Raffaele Scientific Institute, Milan, Italy

Chiara Lanzani, MD

Background

Age-related decline contributes to chronic kidney disease (CKD) progression and worse outcomes, making close monitoring essential. Beyond nephroprotective and cardiometabolic benefits, SGLT2i may influence ageing-related kidney pathways, including Klotho. Yet evidence in elderly, multimorbid populations is limited. Here we evaluate clinical and biological changes following SGLT2i initiation in a real-world cohort of older adults.

Methods

This prospective observational study adresses adults aged ≥65 years initiating SGLT2i at San Raffaele Nephrology Outpatient Clinic, Milan, Italy. At baseline and six-month visits, participants undergo multidimensional assessment including body composition, sarcopenia screening by gastrocnemius ultrasound, handgrip strength, Short Physical Performance Battery (SPPB) and SarQoL questionnaires, blood and urine biobanking for kidney function markers and plasma Klotho levels measurement.

Results

Of the first 54 consecutively enrolled patients, 38 completed follow-up (55% male; median age 75, IQR 70-81 years). Nearly 13% discontinued SGLT2i due to hyponatremia, urinary infection, hospitalization, or no clinical reason. CKD affected 79%, arterial hypertension 97%, diabetes 53%, and heart failure 27% of study cohort. At follow-up, hemoglobin increased (125.4 ± 26.3 vs 134.6 ± 24.2 g/L; p=0.005), consistently in those maintaining SGLT2i (p=0.01). Renal function was preserved, with stable eGFR (47.7, IQR 33.7-53.5 vs 48.6, IQR 27.9-61.0 mL/min/1.73m²; p=0.09) and serum creatinine (1.49 ± 0.47 vs 1.44 ± 0.49 mg/dL) and no correlation with therapy duration. Blood pressure values and orthostatic hypotension prevalence were unchanged. Despite -0.95 ± 2.2 kg body weight reduction, calf circumference, handgrip, and pennation angle were preserved, phase angle, gastrocnemius thickness and SarQoL trended toward improvement. SPPB improved by a median of 1 point (p=0.04). Klotho levels remained stable.

Conclusion

In older adults initiating SGLT2i, early cardiorenal benefits, hemodynamic tolerability, and functional gains were achieved. Treatment discontinuation and incomplete follow-up reflect the challenge of real-world evidence generation in vulnerable populations. Ongoing translational analyses on the full study cohort will help elucidate underlying mechanisms and clinical outcomes to inform therapeutic decision-making.

Acknowledgment

Funded by the European Union - Next Generation EU - NRRP M6C2 - Investment 2.1 Enhancement and strengthening of biomedical research in the NHS"- PNRR-MCNT2-2023-123777474 “Multidisciplinary dissection of renal and metabolic effects of glyfozines on elderly patients”, CUP I63C24000510006

Funding

• Government Support – Non-U.S.