Effects of Sodium-Glucose Cotransporter Type 2 Inhibitors on Residual Kidney Function in Patients Undergoing Incremental Hemodialysis: A Two-Center, Retrospective, Exploratory Cohort Study

Background and Objectives: The preservation of residual kidney function (RKF) is a major determinant of outcome in patients undergoing incremental hemodialysis (iHD). While sodium-glucose cotransporter-2 (SGLT-2) inhibitors have established nephroprotective benefits in non-dialysis chronic kidney disease (CKD), evidence regarding their role in preserving RKF after the initiation of hemodialysis remains limited. The primary objective of this study was to explore the impact of SGLT-2 inhibitors on the preservation of RKF in incident patients undergoing iHD over a 12-month follow-up. Materials and Methods: This study involved a two-center retrospective exploratory observational longitudinal study over 12 months of follow-up, including 32 incident iHD patients (one or two sessions per week, 1WHD or 2WHD). Participants were divided into a study group (SGLT-2iG, n = 15) receiving SGLT-2 inhibitors and a control group (non-SGLT-2iG, n = 17). RKF parameters, including 24 h (h) urine output (UO), urea clearance (KrU), and creatinine clearance (CrCl), were monitored quarterly. Results: Over 12 months, 24 h UO increased significantly within the SGLT-2iG (+573.3 mL; p < 0.001) and did not change significantly within controls (−202.9 mL, p = 0.34). KrU and CrCl showed only non-significant within-group trends (upward in the SGLT-2iG, downward in controls). Between-group differences were not formally tested and are described descriptively. A total of 80% of patients in SGLT-2iG maintained a 1WHD regimen at 12 months, compared with 46.7% in the non-SGLT-2iG. Safety was favorable, with no cases of ketoacidosis or severe infections and a trend toward fewer cardiovascular events in the SGLT-2iG (6.7% vs. 35.3%). Conclusions: In this two-center, real-world cohort, SGLT-2 inhibitor use in incident iHD patients was associated with a within-group increase in 24 h UO and non-significant trends toward preservation of KrU and CrCl over 12 months, together with an apparently favorable safety profile. Given the observational design and small sample, these hypothesis-generating findings should be interpreted with caution and warrant confirmation in dedicated randomized controlled trials.