Table 4 Clinical research recommendations

PEOPLE WITH OR WITHOUT TYPE 2 DIABETES

We recommend further research including, wherever possible, randomised trials to establish definitively:

1

The effects of SGLT-2 inhibition on cardiac and kidney outcomes in people with polycystic kidney disease

2

Safety, cardiovascular and kidney effects of SGLT-2 inhibition on kidney outcomes in people with a functioning kidney transplant (see section 7b of the supplementary appendix)

3

Pharmacokinetics, cardiovascular effects and residual kidney function preservation effects of SGLT-2 inhibition in people on dialysis

4

The safety and efficacy of adding MRA to SGLT-2 inhibition in people with CKD (particularly non-steroidal MRAs with proven cardiovascular and kidney-related benefits)

5

The safety and efficacy of combining SGLT-2 inhibition with a glucagon-like peptide-1 (GLP-1) receptor agonists in people with CKD

6

Detailed cost effectiveness analyses of SGLT-2 inhibition in CKD considering effects across the full range of eGFR and uACR categories

FRACTURE RISK

1

Establishing any long-term impact of SGLT-2 inhibition on the development and progression of CKD mineral bone disease (CKD-MBD)

2

Establishing if SGLT-2 inhibition modifies osteoporosis risk posed by thiazolidinediones

MULTIMORBIDITY AND FRAILTY

1

Future trials of SGLT-2 inhibitor use in people with CKD that seek to extend inclusivity to those of advanced age and multimorbid status

PEOPLE WITH TYPE 1 DIABETES

1

To establish whether the cardiovascular and kidney benefits of SGLT-2 inhibitors extend to those with type 1 DM

2

To establish the safety of SGLT-2 inhibitors in people with type 1 DM and chronic kidney disease

KIDNEY TRANSPLANT RECIPIENTS

1

The generation of reliable randomised trial evidence for transplant recipients is a key research Recommendation

ACUTE DECOMPENSATED HEART FAILURE

1

Large randomised placebo-controlled clinical trials powered to assess hard clinical outcomes in people with ADHF