Frailty Phenotype Among Older Adults Receiving SGLT-2 Inhibitors in a CKD-Predominant Population: A Prospective Cross-Sectional Study

Background and Objectives: Frailty is a multisystem clinical syndrome characterized by reduced physiological reserve and increased vulnerability to adverse health outcomes. It is particularly relevant in older adults with chronic conditions such as chronic kidney disease (CKD). This study aimed to determine the prevalence of frailty and pre-frailty among older adults receiving sodium–glucose cotransporter-2 (SGLT-2) inhibitor therapy in a CKD-predominant population and to evaluate clinical, anthropometric, and laboratory factors associated with frailty status. Materials and Methods: This prospective, cross-sectional study included patients aged ≥60 years receiving SGLT-2 inhibitor therapy for at least one month who underwent frailty assessment during a routine outpatient visit. Frailty status was assessed using a prespecified, modified Fried Physical Frailty Phenotype. Anthropometric and physical performance measurements were obtained using a standardized protocol by the same nephrologist. Results: A total of 163 adults aged ≥60 years receiving SGLT-2 inhibitor therapy were included in this CKD-predominant cohort. Frailty and pre-frailty were identified in 26.4% (95% CI 20.2–33.6%) and 46.0% (95% CI 38.5–53.7%) of participants, respectively. In multivariable logistic regression analysis, higher BMI (aOR 1.12, 95% CI 1.03–1.22; p = 0.010) and higher CCI scores (aOR 1.42, 95% CI 1.12–1.81; p = 0.004) were independently associated with higher odds of non-robust status, whereas higher hemoglobin levels were associated with lower odds (aOR 0.72, 95% CI 0.57–0.91; p = 0.007). Conclusions: Frailty and pre-frailty were common among older adults receiving SGLT-2 inhibitor therapy in this CKD-predominant population. Higher BMI and greater comorbidity burden were independently associated with higher odds of non-robust status, whereas higher hemoglobin levels were associated with lower odds. Frailty assessment may provide complementary information regarding physical reserve and vulnerability in this population rather than serving as a tool for determining eligibility for SGLT-2 inhibitor therapy. Given the study design and absence of a comparator group, no treatment-specific conclusions regarding SGLT-2 inhibitor therapy and frailty can be drawn.