{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:14:59Z","timestamp":1765880099412,"version":"3.48.0"},"reference-count":32,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm14248815","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T15:27:20Z","timestamp":1765553240000},"page":"8815","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sodium-Glucose Cotransporter 2 Inhibitor Use in Adults Undergoing Peritoneal Dialysis: A Propensity-Matched Real-World Data Analysis"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7666-7831","authenticated-orcid":false,"given":"Eric","family":"Amelunxen","sequence":"first","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hauke S.","family":"W\u00fclfrath","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4492-696X","authenticated-orcid":false,"given":"Friedrich A.","family":"von Samson-Himmelstjerna","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph B.","family":"Niehus","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Kolbrink","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Schulte","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roland","family":"Schmitt","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4677-5181","authenticated-orcid":false,"given":"Laura Katharina","family":"Sievers","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"15922","DOI":"10.1038\/s41598-023-42989-z","article-title":"SGLT-2 inhibitors improve cardiovascular and renal outcomes in patients with CKD: A systematic review and meta-analysis","volume":"13","author":"Mavrakanas","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_2","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."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction","volume":"381","author":"McMurray","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"The EMPA-KIDNEY Collaborative Group, Herrington, W.G., Staplin, N., Wanner, C., Green, J.B., Hauske, S.J., Emberson, J.R., Preiss, D., Judge, P., and Mayne, K.J. (2023). Empagliflozin in Patients with Chronic Kidney Disease. N. Engl. J. Med., 388, 117\u2013127.","DOI":"10.1056\/NEJMoa2204233"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2098","DOI":"10.1007\/s00125-018-4669-0","article-title":"The actions of SGLT2 inhibitors on metabolism, renal function and blood pressure","volume":"61","author":"Thomas","year":"2018","journal-title":"Diabetologia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.yjmcc.2022.03.005","article-title":"Cardiac mechanisms of the beneficial effects of SGLT2 inhibitors in heart failure: Evidence for potential off-target effects","volume":"167","author":"Dyck","year":"2022","journal-title":"J. Mol. Cell Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1062","DOI":"10.1016\/j.ekir.2022.02.016","article-title":"Mortality Trends After Transfer From Peritoneal Dialysis to Hemodialysis","volume":"7","author":"Sukul","year":"2022","journal-title":"Kidney Int. Rep. Mai"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Jaar, B.G., Plantinga, L.C., Crews, D.C., Fink, N.E., Hebah, N., Coresh, J., and Kliger, A.S. (2009). Timing, causes, predictors and prognosis of switching from peritoneal dialysis to hemodialysis: A prospective study. BMC Nephrol., 10.","DOI":"10.1186\/1471-2369-10-3"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1001\/jama.2009.1488","article-title":"Cardiovascular and Noncardiovascular Mortality Among Patients Starting Dialysis","volume":"302","author":"Grootendorst","year":"2009","journal-title":"JAMA"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1038\/s44324-025-00068-z","article-title":"SGLT2 inhibitors across various patient populations in the era of precision medicine: The multidisciplinary team approach","volume":"3","author":"McLean","year":"2025","journal-title":"npj Metab. Health Dis."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Jeong, S.J., Lee, S.E., Shin, D.H., Park, I.B., Lee, H.S., and Kim, K.A. (2021). Barriers to initiating SGLT2 inhibitors in diabetic kidney disease: A real-world study. BMC Nephrol., 22.","DOI":"10.1186\/s12882-021-02381-3"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1007\/s11906-024-01314-3","article-title":"Is There a Role for SGLT2 Inhibitors in Patients with End-Stage Kidney Disease?","volume":"26","author":"Siddiqui","year":"2024","journal-title":"Curr. Hypertens Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s41100-024-00523-5","article-title":"SGLT2 inhibitors in peritoneal dialysis: A promising frontier toward improved patient outcomes","volume":"10","author":"Stepanova","year":"2024","journal-title":"Ren. Replace Ther."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ludwig, R.J., Anson, M., Zirpel, H., Thaci, D., Olbrich, H., Bieber, K., Kridin, K., Dempfle, A., Curman, P., and Zhao, S.S. (2025). A comprehensive review of methodologies and application to use the real-world data and analytics platform TriNetX. Front. Pharmacol., 16.","DOI":"10.3389\/fphar.2025.1516126"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s12350-019-01624-z","article-title":"Landmark analysis: A primer","volume":"26","author":"Morgan","year":"2019","journal-title":"J. Nucl. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"4824","DOI":"10.1002\/sim.7019","article-title":"Use of the landmark method to address immortal person-time bias in comparative effectiveness research: A simulation study","volume":"35","author":"Mi","year":"2016","journal-title":"Stat. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies","volume":"46","author":"Austin","year":"2011","journal-title":"Multivar Behav. Res. Mai"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"20f13681","DOI":"10.4088\/JCP.20f13681","article-title":"Mean Difference, Standardized Mean Difference (SMD), and Their Use in Meta-Analysis: As Simple as It Gets","volume":"81","author":"Andrade","year":"2020","journal-title":"J. Clin. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1214\/aos\/1176345976","article-title":"Cox\u2019s Regression Model for Counting Processes: A Large Sample Study","volume":"10","author":"Andersen","year":"1982","journal-title":"Ann. Stat."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1186\/s12933-024-02424-7","article-title":"Exploring the mortality and cardiovascular outcomes with SGLT-2 inhibitors in patients with T2DM at dialysis commencement: A health global federated network analysis","volume":"23","author":"Wang","year":"2024","journal-title":"Cardiovasc. Diabetol."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Sch\u00f6nberger, E., Mihaljevi\u0107, V., Steiner, K., \u0160ari\u0107, S., Kurevija, T., Majnari\u0107, L.T., \u0106ur\u010di\u0107, I.B., and Canecki-Var\u017ei\u0107, S. (2023). Immunomodulatory Effects of SGLT2 Inhibitors\u2014Targeting Inflammation and Oxidative Stress in Aging. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20176671"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1008922","DOI":"10.3389\/fcvm.2022.1008922","article-title":"Anti-inflammatory role of SGLT2 inhibitors as part of their anti-atherosclerotic activity: Data from basic science and clinical trials","volume":"9","author":"Scisciola","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e552","DOI":"10.1016\/S2666-7568(23)00164-2","article-title":"Initiation of SGLT2 inhibitors and GLP-1 receptor agonists according to level of frailty in people with type 2 diabetes and cardiovascular disease in Denmark: A cross-sectional, nationwide study","volume":"4","author":"Malik","year":"2023","journal-title":"Lancet Healthy Longev."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Mascolo, A., Di Napoli, R., Balzano, N., Cappetta, D., Urbanek, K., De Angelis, A., Scisciola, L., Di Meo, I., Sullo, M.G., and Rafaniello, C. (2022). Safety profile of sodium glucose co-transporter 2 (SGLT2) inhibitors: A brief summary. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.1010693"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s00592-018-1116-0","article-title":"SGLT-2 inhibitors and the risk of infections: A systematic review and meta-analysis of randomized controlled trials","volume":"55","author":"Puckrin","year":"2018","journal-title":"Acta Diabetol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ejim.2019.03.014","article-title":"Euglycemic diabetic ketoacidosis","volume":"63","author":"Barski","year":"2019","journal-title":"Eur. J. Intern. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1111\/jdi.12401","article-title":"Euglycemic diabetic ketoacidosis induced by SGLT2 inhibitors: Possible mechanism and contributing factors","volume":"7","author":"Ogawa","year":"2016","journal-title":"J. Diabetes Investig. M\u00e4rz"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"100184","DOI":"10.1016\/j.deman.2023.100184","article-title":"Real-life underuse of SGLT2 inhibitors for patients with type 2 diabetes at high cardiorenal risk","volume":"13","author":"Scheen","year":"2024","journal-title":"Diabetes Epidemiol. Manag."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lai, J.W., Wang, C.C.N., and Chou, C.Y. (2024). SGLT-2 inhibitors in chronic peritoneal dialysis patients: A follow-up study. BMC Nephrol., 25.","DOI":"10.1186\/s12882-024-03683-y"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1177\/08968608211008095","article-title":"SGLT2 inhibition does not reduce glucose absorption during experimental peritoneal dialysis","volume":"41","author":"Martus","year":"2021","journal-title":"Perit. Dial. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1093\/ndt\/gfaf046","article-title":"Rationale and design of the Renal Lifecycle trial assessing the effect of dapagliflozin on cardiorenal outcomes in severe chronic kidney disease","volume":"40","author":"Bakker","year":"2025","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Shukri, A., Mettang, T., Scheckel, B., Schellartz, I., Simic, D., Scholten, N., M\u00fclleru, M., and Stock, S. (2022). Hemodialysis and Peritoneal Dialysis in Germany from a Health Economic View\u2014A Propensity Score Matched Analysis. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192114007"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8815\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T10:10:27Z","timestamp":1765879827000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":32,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248815"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248815","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,12,12]]}}}