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During the congress, E-Posters will be accessible to all participants on the congress website 24/7, as well as in the E-poster stations in the congress center.
Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Sodium–glucose cotransporter 2 (SGLT2) inhibitors have demonstrated kidney and cardiovascular protection in randomized controlled trials of diabetic kidney disease (DKD). However, the evidence regarding their effect on mortality in older adults remains limited, particularly in real-world clinical practice where multimorbidity and frailty are common. Understanding the mortality benefit of SGLT2 inhibitors in this vulnerable population is of critical importance for clinical decision-making.
We emulated a target trial using a nationwide claims and health checkup database in Japan. We identified patients aged ≥65 years with DKD who newly initiated an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor between 2016 and 2023. A total of 5,371 eligible individuals were included. The primary outcome was all-cause mortality. Propensity score overlap weighting was used to balance baseline covariates, and Cox proportional hazards models were applied in both intention-to-treat (ITT) and per-protocol (PP) analyses. We further examined potential effect modification according to age strata (<75, 75–79, ≥80 years), body mass index (BMI), and comorbidity burden assessed by Charlson Comorbidity Index.
During a median follow-up of 2.23 years, 437 deaths were observed. In the weighted ITT analysis, initiation of an SGLT2 inhibitor was associated with a significantly lower risk of all-cause mortality compared with initiation of a DPP4 inhibitor (HR 0.51, 95% CI 0.38–0.70). Similar findings were confirmed in the PP analysis (HR 0.50, 95% CI 0.35–0.73). Subgroup analyses suggested heterogeneity of effect. The mortality benefit of SGLT2 inhibitors was most pronounced in patients younger than 80 years (P for interaction <0.001) and those with BMI ≥22 kg/m². By contrast, in patients aged ≥80 years or with low BMI, the association was attenuated and not statistically significant. Comorbidity burden did not materially modify the treatment effect.
In this nationwide target trial emulation, SGLT2 inhibitor initiation was associated with nearly 50% lower risk of all-cause mortality compared with DPP4 inhibitor initiation among older adults with DKD. The survival benefit was most evident in younger-old individuals and those without underweight, highlighting the importance of patient characteristics in guiding therapy. These findings extend the evidence base of SGLT2 inhibitors to real-world older populations with DKD and support their preferential use for mortality risk reduction in clinical practice.
