Cardiovascular and Renal Benefits of Sglt2 Inhibitors in Chronic Hemodialysis: A Case Report

Abstract

Sodium–glucose cotransporter-2 (SGLT2) inhibitors provide established cardiovascular and renal protection in patients with heart failure and chronic kidney disease, irrespective of diabetes status, but evidence in individuals receiving maintenance hemodialysis remains limited because this population has been excluded from major randomized trials. We report the case of a 76-year-old non-diabetic patient with heart failure with reduced ejection fraction (HFrEF) and end-stage kidney disease undergoing thrice-weekly hemodialysis in whom empagliflozin was initiated 12 months after dialysis initiation. Over two years of follow-up, treatment was well tolerated and associated with improvements in volume status, blood pressure control, and heart failure–related symptoms and overall quality of life, as reflected by a substantial increase in Kansas City Cardiomyopathy Questionnaire scores. Residual kidney function remained preserved, with sustained urine output and measurable residual glomerular filtration rate. Bioimpedance spectroscopy demonstrated reduced overhydration and improved fluid management, accompanied by lower loop diuretic requirements. No major adverse events were observed, apart from a single low urinary tract infection. This case highlights the potential feasibility and cardiorenal benefits of SGLT2 inhibitor initiation in selected hemodialysis patients with HFrEF and residual diuresis. Further randomized controlled studies are needed to clarify safety, mechanisms, and clinical efficacy in this high-risk population.