SGLT2 inhibitors slow CKD progression and raise Lp(a) normalisation in patients with elevated Lp(a), TriNetX cohort of 2,813 matched pairs (J Cardiovasc Pharmacol 2026)

Elevated lipoprotein(a) [Lp(a)] is a known risk factor for cardiovascular disease and may accelerate chronic kidney disease (CKD) progression. Sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated renal protective effects, but their role in patients with concomitantly elevated Lp(a) remains unclear. We conducted a retrospective cohort study using the TriNetX network. Adults (≥18 years) with CKD and Lp(a) ≥50 mg/dL were included. Patients on SGLT2 inhibitors were propensity score-matched 1:1 to those not on therapy (n = 2813 each). Outcomes included CKD progression and cardiovascular events at 1-year, 3-year, and 5-year follow-up. Risk ratios, hazard ratios, and 95% confidence intervals were calculated. SGLT2 inhibitor use was associated with reduced CKD progression at 3 and 5 years and a higher likelihood of achieving Lp(a) normalization. At 5 years, the risks of ischemic stroke and peripheral artery disease were also lower in the SGLT2 cohort. No significant differences were observed for myocardial infarction at earlier follow-up, whereas composite outcomes were reduced at longer follow-up. In patients with CKD and elevated Lp(a), SGLT2 inhibitors were associated with slower CKD progression and a greater likelihood of achieving Lp(a) normalization over 5 years, suggesting a potential benefit in this high-risk population.