SODIUM-GLUCOSE COTRANSPORTER-2 INHIBITORS BEYOND DIABETES: AN EMERGING CARDIORENAL STRATEGY IN INTERNAL MEDICINE

Sodium-glucose cotransporter-2 (SGLT2) inhibitors were initially developed as glucose-lowering agents for patients with type 2 diabetes mellitus. However, accumulating evidence has demonstrated substantial cardiovascular and renal benefits that extend beyond glycemic control and may occur independently of diabetes status. To review the current evidence regarding the use of SGLT2 inhibitors as a cardiorenal therapeutic strategy in patients with heart failure and chronic kidney disease, with particular emphasis on recent clinical trials and contemporary recommendations. A narrative review of contemporary evidence was conducted using major randomized controlled trials, systematic reviews, and international clinical practice guidelines addressing SGLT2 inhibitors in heart failure and chronic kidney disease. Particular attention was given to evidence published between 2023 and 2026, including the EMPA-KIDNEY follow-up data and recent European and international recommendations. SGLT2 inhibitors consistently reduce the risk of hospitalization for heart failure and slow the progression of chronic kidney disease. Their benefits have been demonstrated across different left ventricular ejection fraction categories and in patients with and without type 2 diabetes. Recent long-term follow-up of EMPA-KIDNEY demonstrated a sustained reduction in the composite risk of kidney disease progression or cardiovascular death among patients receiving empagliflozin. Contemporary evidence also supports early incorporation of SGLT2 inhibitors into guideline-directed medical therapy for heart failure. SGLT2 inhibitors represent an important therapeutic paradigm shift in internal medicine. Their cardiovascular and renal effects extend beyond glucose lowering, supporting their use as disease-modifying agents in appropriate patients with heart failure and chronic kidney disease, regardless of diabetes status.