Frailty-related factors and 1-year renal function change after sodium-glucose cotransporter-2 inhibitors in elderly chronic kidney disease patients

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are first-line therapy for chronic kidney disease (CKD).However, evidence regarding their safety and efficacy in frail elderly patients remains limited.This study evaluated the impact of frailty-related factors on renal outcomes in elderly CKD patients treated with SGLT2i.Methods: We retrospectively analyzed 302 elderly CKD patients (65 years) newly prescribed SGLT2i.Four frailty-related factors included advanced age (75 years), anemia, low Geriatric Nutritional Risk Index (GNRI 98), and proteinuria.Rapid renal decline was defined as an absolute decrease in estimated glomerular filtration rate (eGFR) >10 mL/min/1.73m within 12 months or a 40% reduction from baseline.Results: The mean age was 75.7 8.1 years, and baseline eGFR was 48.1 mL/min/1.73m.Anemia was present in 49.3% and low GNRI in 12.3% of patients.Those with low GNRI were older, had lower BMI and serum albumin levels, higher prevalence of anemia and proteinuria, and greater 12-month decline in eGFR (-4.0 mL/min/1.73m2 vs. -2.0mL/min/1.73m2/year, p < 0.01).Rapid renal decline occurred in 29 patients (9.6%), and risk increased with accumulation of frailty factors.Advanced age (75 years) alone was associated with higher risk (odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03-5.32),which further increased when combined with anemia and proteinuria (OR, 4.85; 95% CI,.Patients with all four components had the highest risk (OR, 9.70; 95% CI,).Conclusion: While SGLT2i are generally effective in elderly CKD patients, those with frailty-related factors, particularly malnutrition, proteinuria, and anemia, appear to be at higher risk of rapid decline in renal function.These patients may benefit from more individualized risk assessment and management.