We provide an up-to-date meta-analysis of trials showing  
the benefits of SGLT2i for the reduction of cardiorenal mor- 
bidity and mortality in individuals living with HF or CKD  
and we reappraise the comparison of SGLT2i in people with  
T2D as well.Additionally, the significant but modest reduction in  
non-fatal MI of 10% with SGLT2i remains not significantly  
different from the 6%-point estimate reduction associated  
with GLP-1 RA, which itself is not significant.In the current analy- 
sis, however, the risk reduction associated with SGLT2iWe believe, therefore, that the existing CCS  
guidelines recommending use of an SGLT2i in adults with  
CKD (UACR>20  mg/mmol, eGFR>=25 mL/min/1.73m2)  
to reduce the composite of a significant decline in eGFR,  
progression to end-stage kidney disease or death due to kid- 
ney disease, all-cause and CV mortality, non-fatal MI, and  
hospitalization for HF remain largely unchanged although  
a slightly lower eGFR of 20 mL/min/1.73m2 would be con- 
sidered reasonable.Finally, it is impor- 
tant to note that the prior CCS cardiorenal guideline com- 
mittee did not feel that recommendations regarding either  
HF or CKD protection using GLP1-RA were warranted in  
the absence of published, dedicated trials in these popula- 
tions.The EMPA-Kidney trial is unique in adding informa- 
tion to participants with CKD defined by an eGFR of at  
least 20 mL/min/1.73m2 but less than 45 mL/min/1.73m2  
of body-surface area, or who had an eGFR of at least 45  
mL/min/1.73m2 but less than 90 mL/min/1.73m2 with a  
urinary albumin-to-creatinine ratio (with albumin mea- 
sured in milligrams and creatinine measured in grams) of  
at least 200.The effect on  
the combined outcome of CV mortality or HF hospitaliza- 
tion also remained unchanged (25% reduction) despite the  
data from two additional trials (DELIVER and EMPULSE,  
Fig.