AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
SGLT2 Inhibitor Use in ESRD and HFrEF: A Retrospective Outcomes Analysis
By Sharma S, Ali M, Jamil R et al.
BACKGROUND: SGLT2 inhibitors have shown benefits in HFrEF by reducing cardiovascular death, heart failure hospitalizations, and CKD progression. Their use in ESRD patients who are dependent on dialysis is more limited and nuanced due to reduced glucosuric and natriuretic effects. However, SGLT2 inhibitors have direct cardiac and vascular effects, lowering intracellular sodium and calcium in cardiomyocytes and reducing oxidative stress, fibrosis, and autophagy. There is emerging, albeit limited, randomized trial data indicating a potential benefit. Subgroup data from advanced CKD trials, such as the DAPA-CKD trial and post-hoc analyses, support the persistence of cardiorenal benefits of SGLT2 inhibitors after dialysis initiation. METHODS: This analysis used the TriNetX Global Collaborative Network. Cohort 1 included patients who were age >18 years, had ESRD dependent on renal dialysis, systolic heart failure, LVEF ≤40%, and exposure to an SGLT2 inhibitor: dapagliflozin, empagliflozin, ertugliflozin, or canagliflozin. Cohort 2 had the same inclusion criteria but was not prescribed any SGLT2 inhibitor. Propensity score matching was used, and both cohorts included 998 patients per group after matching. Outcomes included all-cause mortality, STEMI or acute MI, stroke, atrial fibrillation, heart failure outcome, ER visit or hospitalization, and ventricular tachycardia or ventricular fibrillation. RESULTS: All-cause mortality was significantly lower among SGLT2 inhibitor users on Kaplan-Meier survival analysis (HR 0.757, 95% CI 0.666-0.861; log-rank p <0.001). Risk analysis showed lower rates of STEMI/acute MI (RR 0.685, 95% CI 0.534-0.878), atrial fibrillation (RR 0.617, 95% CI 0.470-0.810), and heart failure events (RR 0.838, 95% CI 0.714-0.983), although Kaplan-Meier analyses for these outcomes were not statistically significant. No significant differences were observed in stroke (RR 0.776, 95% CI 0.531-1.133), ER visit/hospitalization (RR 0.980, 95% CI 0.944-1.018), and VT/VF risk (RR 0.963, 95% CI 0.864-1.073). CONCLUSION: There is a potential mortality benefit associated with SGLT2 inhibitor use in patients with ESRD and HFrEF. In this retrospective analysis, SGLT2 inhibitor use was associated with lower all-cause mortality. Given the observational design, these findings warrant further prospective studies.