Sodium-Glucose Cotransporter 2 Inhibitor Use in Adults Undergoing Peritoneal Dialysis: A Propensity-Matched Real-World Data Analysis.

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have become key therapeutic agents based on their protective cardiovascular and renal effects. However, their safety and efficacy in patients with kidney failure, especially undergoing peritoneal dialysis (PD), who are a population at very high cardiovascular risk, remain largely unexplored. Methods: We conducted a retrospective global cohort study using the electronic health records of 19,871 adult peritoneal dialysis patients from the Global Collaborative Network TriNetX database. Of these, n = 412 patients used SGLT2is within 3 months after PD initiation. After propensity score matching, n = 367 patients per cohort were evaluated for cardiovascular risk, mortality and adverse events related to SGLT2is-treatment. Results: The mean age of PD patients with SGLT2is use was 58.7 years and common comorbidities were heart failure (74.0%) and type 2 diabetes (62.1%). Comedication included beta blocking agents (75.5%), diuretics (74.0%), statins (64.6%), insulins (60.2%) and renin- angiotensin blockade (56.3%) in the majority of patients. After propensity score matching, SGLT2is use showed a trend towards reduced all-cause mortality or major adverse cardiovascular events but no significant risk reduction. Further, incidence of hemodialysis was not lowered by SGLT2is use. Known adverse events of SGLT2is use such as ketoacidosis, genitourinary infections, dehydration or peritonitis were not increased among users. Conclusions: In this cohort of PD patients with high cardiovascular and metabolic risk factors, SGLT2is use was safe with regard to unchanged adverse events, while effects on mortality, cardiovascular outcomes, and technique failure were neutral.