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Do SGLT2 inhibitors protect elderly patients from HF rehospitalization and CKD progression? More opportunities than concerns

  • Andrea Galassi
    Correspondence
    Corresponding author at: Renal & Dialysis Unit, ASST Santi Paolo e Carlo, Milan, Italy.
    Affiliations
    Renal & Dialysis Unit, ASST Santi Paolo e Carlo, Milan, Italy

    Department of Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
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  • Anila Cara
    Affiliations
    Renal & Dialysis Unit, ASST Santi Paolo e Carlo, Milan, Italy

    Department of Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
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  • Lorenza Magagnoli
    Affiliations
    Renal & Dialysis Unit, ASST Santi Paolo e Carlo, Milan, Italy

    Department of Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
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  • Federico Maffei Faccioli
    Affiliations
    Renal & Dialysis Unit, ASST Santi Paolo e Carlo, Milan, Italy

    Department of Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
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  • Mario Cozzolino
    Affiliations
    Renal & Dialysis Unit, ASST Santi Paolo e Carlo, Milan, Italy

    Department of Health Sciences, Renal Division, University of Milan, San Paolo Hospital, Milan, Italy
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Published:October 28, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.10.155
      The pace of population aging in developed countries is much faster than in the past. Meanwhile, in order to treat highly prevalent diseases such as diabetes, heart failure (HF) and chronic kidney disease (CKD), new options are emerging. Sodium glucose co-transporter inhibitors (SGLT2i) were shown to drastically reduce the risk of mortality, rehospitalization for HF and decline of renal function in diabetic and non-diabetic patients [
      • Lin D.S.H.
      • Lee J.K.
      • Hung Ch.
      • et al.
      The efficacy and safety of novel classes of glucose-lowering drugs for cardiovascular outcomes: a network meta-analysis of randomised clinical trials.
      ]. However, randomized controlled trials (RCTs), designed for ascertaining the efficacy and the safety of such treatment, were not tailored to elderly cohorts. Considering the elevated risk of hospitalization related to HF, CKD and diabetes in elderly patients on the one hand, and the concerns related to medical treatments side effects such as diuretics, antidiabetic drugs and renin- angiotensin - system inhibitors (RASI) in frail individuals on the other, attention should be focused on the net risk-benefit ratio of SGLT2i prescription in older patients.
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