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Sodium-glucose cotransporter-2 inhibitors (SGLT2is) provide renal protection in diabetes, but their long-term effects in this high-risk population remain unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>To evaluate whether SGLT2i use reduces the risk of KRT and all-cause mortality in adults with BD and mild-to-moderate CKD (stage\u2009\u2a7d\u20093).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Observational cohort study with propensity score matching (PSM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>\n                      In this study using TriNetX (2009\u20132024) real-world database, 89,369 adults with BD and mild-to-moderate CKD were classified as SGLT2i users (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200912,736) or nonusers (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200976,633). Primary outcomes were progression to KRT and all-cause mortality over 5\u2009years. Adjusted hazard ratios (aHRs) were estimated using Cox proportional hazards models, and 1:1 PSM reduced confounding. Subgroup analyses examined sex, race\/ethnicity, diabetes status, CKD stage, and mood stabilizer use.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      SGLT2i use was associated with lower risk of KRT (aHR 0.47 (95% CI, 0.42\u20130.53)) and all-cause mortality (aHR 0.69 (95% CI, 0.65\u20130.73); both\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Protective effects were consistent across subgroups, including individuals receiving lithium, lamotrigine, valproate, or antipsychotics. After PSM (10,967 matched pairs), 5-year KRT-free survival was 94.61% versus 90.99%, and overall survival was 78.67% versus 67.53% (both\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Given the observational design, the possibility of residual or unmeasured confounding canot be excluded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>SGLT2i therapy in individuals with BD and mild-to-moderate CKD is associated with substantially lower risks of KRT and all-cause mortality. Prospective trials are needed to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20451253261423437","type":"journal-article","created":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T16:59:17Z","timestamp":1771606757000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Sodium-glucose cotransporter-2 inhibitors lower risk of kidney replacement therapy and mortality in bipolar disorder with chronic kidney disease"],"prefix":"10.1177","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7062-8192","authenticated-orcid":false,"given":"Balwinder","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Behavioral Health, Pennsylvania State College of Medicine, Hershey, PA, USA"},{"name":"Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria L.","family":"Gonzalez Suarez","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ritika","family":"Baweja","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Health, Pennsylvania State College of Medicine, Hershey, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0652-0862","authenticated-orcid":false,"given":"Osama A.","family":"Abulseoud","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic Arizona, Phoenix, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika F. 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