Clinical and Medication-Related Factors Associated with Adverse Renal Outcomes in Advanced Chronic Kidney Disease Patients Treated with Empagliflozin: A Real-World Study in Thailand

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have been shown to reduce the rate of chronic kidney disease (CKD) progression and provide cardioprotective benefits beyond glycemic control. However, evidence regarding their effects on kidney disease progression in advanced CKD patients remains limited. Objectives: To determine the proportion of patients who developed adverse renal outcomes (AROs) and identify factors associated with AROs among patients with advanced CKD following SGLT2 inhibitor initiation. Methods: This retrospective cohort study was conducted in a tertiary-care hospital in Thailand. Patients with advanced CKD who initiated SGLT2 inhibitor therapy between 1 January 2021 and 31 March 2025 were included. Descriptive statistics were used to summarize the data. Factors associated with AROs were evaluated using Cox proportional hazards regression analysis. Results: A total of 132 patients were included for analysis. All patients received empagliflozin. Most patients were aged ≥60 years (77.27%), and 53.79% were female. During the follow-up period, 24.2% of patients experienced AROs. Multivariable analysis identified CKD stage 5 (aHR = 4.02, 95% CI: 1.92–8.44, p < 0.001) and concomitant use of low-dose aspirin (aHR = 2.35, 95% CI: 1.05–5.26, p = 0.038) as factors independently associated with an increased risk of AROs. Conclusions: Approximately one-quarter of patients with advanced CKD experienced an ARO, following empagliflozin initiation. CKD stage 5 and concomitant low-dose aspirin use were independently associated with AROs. Patients with these characteristics may warrant closer monitoring of renal function, particularly in those with more advanced disease during empagliflozin therapy.