For adults aged 80 and older with chronic kidney disease, treatment with a class of medicines called SGLT2 inhibitors was linked to lower risks of death and serious heart and kidney problems over two years. The findings were presented in Denver at Kidney Week, the annual meeting of the American Society of Nephrology, held Oct. 21 to 25.
Chronic kidney disease can raise the risk of other health problems, but people in their 80s and older are often left out of large medical trials. Frailty and other illnesses can make it harder to study treatments in this group. That leaves doctors with less evidence about how medicines may work for some of their oldest patients.
Julian Doricic, M.D., of Medizinische Hochschule Hannover in Germany, and colleagues used records from the TriNetX database to examine SGLT2 inhibitor therapy. Their analysis included 23,765 people aged 80 and older with chronic kidney disease, including both users and nonusers of the medicines. The researchers matched the groups based on other illnesses, laboratory results and factors linked to frailty, aiming to make the comparison more balanced.
After two years, people taking SGLT2 inhibitors had a lower risk of death than those who did not take them. The adjusted hazard ratio for death was 0.734, a measure indicating a lower rate in the treated group after accounting for factors included in the analysis. The researchers reported a similar mortality benefit across all the subgroups they had defined in advance.
The users also had lower risks of major adverse cardiovascular events, such as serious heart-related problems, and major adverse kidney events. The adjusted hazard ratios were 0.884 for cardiovascular events and 0.775 for kidney events. These results show an association in the study data; they do not prove that the medicines alone caused the differences.
The study adds evidence on a group that has often been missing from large randomized trials, in which participants are assigned to treatments by chance. Co-author Bernhard M.W. Schmidt, M.D., of Hannover Medical School in Germany, said real-world data can help address this gap. He also stressed that care for very elderly people must be tailored to each person.
“These patients require a careful, individualized risk-benefit assessment and close clinical monitoring,” Schmidt said. The findings offer a reason for clinicians to consider what SGLT2 inhibitors may mean for older adults with chronic kidney disease, while weighing each patient’s health and needs. More study can help clarify how best to use the medicines in this age group.