{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:49:36Z","timestamp":1791560976476,"version":"4.3.4"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","funder":[{"name":"AstraZeneca M\u00f6lndal"},{"name":"Stockholm l\u00e4ns landsting"},{"name":"Stiftelsen Stig och Gunborg Westman","id":[{"id":"https:\/\/ror.org\/03kf77330","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Stiftelsen f\u00f6r njursjuka"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>In nationwide nephrology-referred CKD, sodium-glucose cotransporter 2 inhibitor use was associated with lower cardiovascular event and KRT risk.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Associations with cardiovascular events and KRT were consistent in advanced CKD, a group underrepresented in trials.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Findings supported the applicability of trial results to a broad nephrology-referred CKD population.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) reduce cardiovascular (CV) and kidney events in randomized trials, yet evidence on their effectiveness in routine nephrology practice remains limited. We examined CV and kidney outcomes associated with SGLT2 inhibitor initiation in adults with CKD receiving specialist nephrology care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this nationwide cohort study, we included adults with CKD receiving specialist nephrology care, identified through the Swedish Renal Registry between January 1, 2016, and December 31, 2023. Participants had baseline data on eGFR, urine albumin-to-creatinine ratio, and hemoglobin; those with prior KRT were excluded. Follow-up continued until December 31, 2024. SGLT2 inhibitor use was identified through national pharmacy records and analyzed according to an intention-to-treat approach. Outcomes were major adverse cardiovascular events (MACE), initiation of KRT, all-cause mortality, and a composite of heart failure hospitalization or CV death. Associations were estimated using inverse probability\u2013weighted marginal structural models to address time-dependent confounding.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 32,856 participants (median age 73 years [interquartile range, 63\u201379]; 36% women; mean eGFR 29.3\u00b116.8 ml\/min per 1.73 m\n                      <jats:sup>2<\/jats:sup>\n                      ), 1493 (4.5%) were prevalent SGLT2 inhibitor users at baseline and 3491 (10.6%) initiated treatment during follow-up (4984 ever-exposed, 15.2%). SGLT2 inhibitor use was associated with a lower risk of MACE (odds ratio 0.80, 95% confidence interval, 0.71 to 0.91) and KRT (0.67, 0.52 to 0.85). No associations were observed for all-cause mortality (0.95, 0.79 to 1.15) or the composite heart failure outcome (0.87, 0.65 to 1.16), although a lower risk was observed in the incident-user analysis (0.61, 0.38 to 0.98). Associations were generally consistent across prespecified subgroups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In adults with CKD managed in specialist nephrology care, SGLT2 inhibitor use was associated with a lower risk of MACE and KRT, extending randomized trial evidence to a broad, real-world CKD population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2215\/cjn.0000001160","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T20:37:29Z","timestamp":1786048649000},"page":"1733-1743","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular and Kidney Outcomes following Sodium-Glucose Cotransporter 2 Inhibitor Initiation in CKD"],"prefix":"10.2215","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7214-1819","authenticated-orcid":false,"given":"Joakim","family":"\u00d6sterman","sequence":"first","affiliation":[{"name":"Department of Clinical Intervention and Technology (CLINTEC), Renal Medicine, Karolinska Institutet, Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehab","family":"Al-Sodany","sequence":"additional","affiliation":[{"name":"Department of Clinical Intervention and Technology (CLINTEC), Renal Medicine, Karolinska Institutet, Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3444-3244","authenticated-orcid":false,"given":"Peter","family":"Hemmingsson","sequence":"additional","affiliation":[{"name":"Department of Clinical Intervention and Technology (CLINTEC), Renal Medicine, Karolinska Institutet, Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ida Haugen","family":"L\u00f6fman","sequence":"additional","affiliation":[{"name":"Department of Medicine Solna, Unit of Cardiology, Heart and Vascular Theme, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6501-8293","authenticated-orcid":false,"given":"Peter","family":"Barany","sequence":"additional","affiliation":[{"name":"Department of Clinical Intervention and Technology (CLINTEC), Renal Medicine, Karolinska Institutet, Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8650-5795","authenticated-orcid":false,"given":"Marie","family":"Evans","sequence":"additional","affiliation":[{"name":"Department of Clinical Intervention and Technology (CLINTEC), Renal Medicine, Karolinska Institutet, Huddinge, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"issue":"10","key":"B1-20261009","doi-asserted-by":"crossref","first-page":"4405","DOI":"10.1007\/s12325-023-02608-9","article-title":"Global economic burden associated with chronic kidney disease: a pragmatic review of medical costs for the inside CKD research programme","volume":"40","author":"Jha","year":"2023","journal-title":"Adv Ther."},{"issue":"11","key":"B2-20261009","doi-asserted-by":"crossref","first-page":"825","DOI":"10.7326\/0003-4819-158-11-201306040-00007","article-title":"Evaluation and management of chronic kidney disease: synopsis of the KDIGO 2012 clinical practice guideline","volume":"158","author":"Stevens","year":"2013","journal-title":"Ann Intern Med."},{"key":"B3-20261009","doi-asserted-by":"crossref","first-page":"f360","DOI":"10.1136\/bmj.f360","article-title":"Efficacy and safety of dual blockade of the renin\u2013angiotensin system: meta-analysis of randomized trials","volume":"346","author":"Makani","year":"2013","journal-title":"BMJ."},{"issue":"10","key":"B4-20261009","doi-asserted-by":"crossref","first-page":"2758","DOI":"10.1681\/ASN.2007040422","article-title":"Age affects outcomes in chronic kidney disease","volume":"18","author":"O\u2019Hare","year":"2007","journal-title":"J Am Soc Nephrol."},{"issue":"10","key":"B5-20261009","doi-asserted-by":"crossref","first-page":"752","DOI":"10.1161\/CIRCULATIONAHA.116.021887","article-title":"Sodium\u2013glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and kidney effects, potential mechanisms, and clinical applications","volume":"134","author":"Heerspink","year":"2016","journal-title":"Circulation."},{"issue":"10166","key":"B6-20261009","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(18)32590-X","article-title":"SGLT2 inhibitors for primary and secondary prevention of cardiovascular and renal outcomes in type 2 diabetes: a meta-analysis of cardiovascular outcome trials","volume":"393","author":"Zelniker","year":"2019","journal-title":"Lancet."},{"issue":"24","key":"B7-20261009","doi-asserted-by":"crossref","first-page":"2295","DOI":"10.1056\/NEJMoa1811744","article-title":"Canagliflozin and renal outcomes in type 2 diabetes and nephropathy","volume":"380","author":"Perkovic","year":"2019","journal-title":"N Engl J Med."},{"issue":"15","key":"B8-20261009","doi-asserted-by":"crossref","first-page":"1436","DOI":"10.1056\/NEJMoa2024816","article-title":"Dapagliflozin in patients with chronic kidney disease","volume":"383","author":"Heerspink","year":"2020","journal-title":"N Engl J Med."},{"issue":"2","key":"B9-20261009","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1056\/NEJMoa2204233","article-title":"Empagliflozin in patients with chronic kidney disease","volume":"388","author":"Herrington","year":"2023","journal-title":"N Engl J Med."},{"issue":"1","key":"B10-20261009","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S2213-8587(19)30384-5","article-title":"Kidney outcomes associated with use of SGLT2 inhibitors in real-world clinical practice (CVD-REAL 3): a multinational observational cohort study","volume":"8","author":"Heerspink","year":"2020","journal-title":"Lancet Diabetes Endocrinol."},{"issue":"5","key":"B11-20261009","doi-asserted-by":"crossref","first-page":"658","DOI":"10.1210\/endrev\/bnab007","article-title":"Conducting real-world evidence studies on the clinical outcomes of diabetes treatments","volume":"42","author":"Schneeweiss","year":"2021","journal-title":"Endocr Rev."},{"issue":"9","key":"B12-20261009","doi-asserted-by":"crossref","first-page":"sfaf238","DOI":"10.1093\/ckj\/sfaf238","article-title":"The Swedish renal registry: a nationwide registry for chronic kidney disease of all stages","volume":"18","author":"Faucon","year":"2025","journal-title":"Clin Kidney J."},{"issue":"7","key":"B14-20261009","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1002\/pds.1294","article-title":"The new Swedish prescribed drug register\u2014opportunities for pharmacoepidemiological research and experience from the first six months","volume":"16","author":"Wettermark","year":"2007","journal-title":"Pharmacoepidemiol Drug Saf."},{"issue":"4S","key":"B15-20261009","first-page":"S117","article-title":"KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease","volume":"105","year":"2024","journal-title":"Kidney Int"},{"key":"B16-20261009","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health."},{"issue":"9","key":"B17-20261009","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann Intern Med."},{"issue":"4","key":"B18-20261009","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1177\/1536867X0400400403","article-title":"Controlling for time-dependent confounding using marginal structural models","volume":"4","author":"Fewell","year":"2004","journal-title":"Stata J."},{"issue":"12","key":"B19-20261009","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1002\/sim.4780091214","article-title":"Relation of pooled logistic regression to time dependent cox regression analysis: the Framingham heart study","volume":"9","author":"D'Agostino","year":"1990","journal-title":"Stat Med."},{"issue":"6","key":"B20-20261009","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1093\/aje\/kwn164","article-title":"Constructing inverse probability weights for marginal structural models","volume":"168","author":"Cole","year":"2008","journal-title":"Am J Epidemiol."},{"issue":"8","key":"B21-20261009","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1056\/NEJMoa2409183","article-title":"Long-term effects of empagliflozin in patients with chronic kidney disease","volume":"392","author":"Herrington","year":"2025","journal-title":"N Engl J Med."},{"issue":"10","key":"B22-20261009","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1093\/ndt\/gfaf051","article-title":"SGLT2 inhibitors in CKD: are they really effective in all patients?","volume":"40","author":"Romagnani","year":"2025","journal-title":"Nephrol Dial Transplant."},{"issue":"3","key":"B23-20261009","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jama.2025.20834","article-title":"SGLT2 inhibitors and kidney outcomes by glomerular filtration rate and albuminuria: a meta-analysis","volume":"335","author":"Neuen","year":"2026","journal-title":"JAMA."},{"issue":"6","key":"B24-20261009","doi-asserted-by":"crossref","first-page":"921","DOI":"10.1007\/s11606-023-08397-9","article-title":"Effects of dapagliflozin in chronic kidney disease across the spectrum of age and sex","volume":"39","author":"Yu","year":"2024","journal-title":"J Gen Intern Med."},{"key":"B25-20261009","doi-asserted-by":"crossref","first-page":"102426","DOI":"10.1016\/j.eclinm.2024.102426","article-title":"Implementation of chronic kidney disease guidelines for sodium-glucose co-transporter-2 inhibitor use in primary care in the UK: a cross-sectional study","volume":"68","author":"Forbes","year":"2024","journal-title":"EClinicalMedicine."},{"issue":"8","key":"B26-20261009","doi-asserted-by":"crossref","first-page":"sfae100","DOI":"10.1093\/ckj\/sfae100","article-title":"Dapagliflozin treatment of patients with chronic kidney disease without diabetes across different albuminuria levels (OPTIMISE-CKD)","volume":"17","author":"Svensson","year":"2024","journal-title":"Clin Kidney J."},{"key":"B27-20261009","doi-asserted-by":"crossref","first-page":"1236404","DOI":"10.3389\/fendo.2023.1236404","article-title":"Cardiovascular outcomes and safety of SGLT2 inhibitors in chronic kidney disease patients","volume":"14","author":"Chen","year":"2023","journal-title":"Front Endocrinol (Lausanne)."},{"issue":"5","key":"B29-20261009","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1016\/j.ejheart.2004.12.007","article-title":"The validity of a heart failure diagnosis in a hospital discharge register","volume":"7","author":"Ingelsson","year":"2005","journal-title":"Eur J Heart Fail."},{"issue":"1","key":"B30-20261009","first-page":"36","article-title":"Validity of heart failure diagnoses made in 2000-2012 in western Sweden","volume":"7","author":"Schaufelberger","year":"2020","journal-title":"ESC Heart Fail"},{"issue":"3","key":"B31-20261009","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1007\/s10654-025-01221-0","article-title":"Diagnostic accuracy in the Swedish National Patient Register: a review including diagnoses in the outpatient register","volume":"40","author":"Everhov","year":"2025","journal-title":"Eur J Epidemiol."},{"issue":"5","key":"B32-20261009","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1016\/j.xkme.2021.04.009","article-title":"SGLT2 inhibitors and kidney and cardiac outcomes according to estimated GFR and albuminuria levels: a meta-analysis of randomized controlled trials","volume":"3","author":"Chun","year":"2021","journal-title":"Kidney Med."},{"issue":"6","key":"B33-20261009","doi-asserted-by":"crossref","first-page":"693","DOI":"10.7326\/M23-1874","article-title":"Sodium\u2013glucose cotransporter-2 inhibitors and the risk for dialysis and cardiovascular disease in patients with stage 5 chronic kidney disease","volume":"177","author":"Yen","year":"2024","journal-title":"Ann Intern Med."},{"issue":"3","key":"B34-20261009","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1007\/s12325-023-02773-x","article-title":"Dapagliflozin utilization in chronic kidney disease and its real-world effectiveness among patients with lower levels of albuminuria in the USA and Japan","volume":"41","author":"Tangri","year":"2024","journal-title":"Adv Ther."},{"issue":"1","key":"B35-20261009","doi-asserted-by":"crossref","first-page":"1667","DOI":"10.1038\/s41598-025-86172-y","article-title":"Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease","volume":"15","author":"Hunsuwan","year":"2025","journal-title":"Sci Rep."},{"issue":"5","key":"B36-20261009","doi-asserted-by":"crossref","first-page":"1615","DOI":"10.1111\/dom.15461","article-title":"Renal outcomes with sodium-glucose cotransporter 2 inhibitors in Japanese people with grade 3 chronic kidney disease and type 2 diabetes: analysis of medical administrative databases","volume":"26","author":"Iijima","year":"2024","journal-title":"Diabetes Obes Metab."},{"issue":"8","key":"B37-20261009","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1161\/CIRCRESAHA.122.321748","article-title":"The cardio-kidney patient: epidemiology, clinical characteristics and therapy","volume":"132","author":"Schuett","year":"2023","journal-title":"Circ Res."},{"issue":"1","key":"B38-20261009","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1186\/s12874-021-01440-5","article-title":"Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review","volume":"21","author":"Bosco","year":"2021","journal-title":"BMC Med Res Methodol."}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001160","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T15:01:09Z","timestamp":1791558069000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2215\/CJN.0000001160"}},"subtitle":["A Swedish Nationwide Cohort Study"],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":36,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.0000001160","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]},"assertion":[{"value":"2026-03-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-03","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}