(B-039) SGLT2 inhibitors and major renal outcomes among Medicare beneficiaries with heart failure

Monday, August 25, 2025

11:30 AM - 1:00 PM ET

Presenting Author(s)

TS

Tsung-Hua Shen, MS, BPharm

PhD candidate
Social & Administrative Pharmacy Program, Department of Pharmaceutical Care & Health Systems, College of Pharmacy, University of Minnesota, United States

Co-Author(s)

JF

Joel Farley, PhD

Professor
Department of Pharmaceutical Care & Heath Systems, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, Minnesota, United States
JS

John Schommer, MS, PhD, RPh

Professor
Department of Pharmaceutical Care and Health Systems, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota, Minnesota, United States
EW

Eric Weinhandl, PhD

University of Minnesota, College of Pharmacy, Department of Pharmaceutical Care & Health Systems, United States
HP

Helen Parsons

Division of Health Policy & Management, School of Public Health, University of Minnesota, United States

Background: Over one-third of heart failure (HF) patients may develop end-stage renal disease (ESRD), significantly worsening their prognosis. While SGLT2 inhibitors show promise in improving HF and renal outcomes, clinical trials are limited by short durations and limited population diversity.

Objectives: This study uses real-world data to evaluate long-term renal outcomes, providing insights into the effectiveness of SGLT2 inhibitors

Methods: This retrospective cohort study compared SGLT2 to dipeptidyl peptidase-4 (DPP-4) inhibitors using Medicare claims data from 2014-2019. We included Medicare beneficiaries with type 2 diabetes (T2D) and HF, excluding those with established ESRD. The primary outcomes were end-stage renal disease (ESRD) and acute kidney injury (AKI)-related hospitalizations. A Fine-Gray competing risk model was incorporated with inverse probability treatment weighting and time-varying adherence weighting to estimate per-protocol treatment effects.

Results: We compared 1,920 SGLT2 inhibitor users to 10,324 DPP-4 inhibitor users over a 2.7-year follow-up. The adjusted incidence rates of ESRD were 1.33 and 2.31 per 100 person-years for the SGLT2 and DPP-4 inhibitor groups. In per-protocol analyses, SGLT2 inhibitor use was associated with a 42% reduction in risk of ESRD compared to DPP-4 inhibitors (HR, 0.58; 95% CI, 0.43-0.78). Subgroup analyses showed significant risk reduction across sex, race, and in a few specific comorbidities, including obesity, ischemic heart disease, and stroke. Additionally, SGLT2 inhibitors significantly reduced the risk of AKI-related hospitalizations risk by 18% (HR, 0.82; 95%CI, 0.71-0.98).

Conclusions: SGLT2 inhibitor use significantly reduces the risk of major renal outcomes among Medicare beneficiaries with HF and T2 across multiple comorbidities. Our findings support previous clinical trial results while addressing their limitations by including a more heterogeneous population, enhancing the generalizability of the evidence.