Sodium-Glucose Cotransport Protein 2 Inhibitors in Patients With Type 2 Diabetes and Acute Kidney Disease

Abstract

ImportanceSodium-glucose cotransport protein 2 inhibitors (SGLT-2is) have demonstrated associations with positive kidney-related and cardiovascular outcomes in patients with type 2 diabetes. However, the association of SGLT-2is with outcomes among patients with type 2 diabetes and acute kidney disease (AKD) remains unclear.ObjectiveTo examine the long-term associations of SGLT-2is with mortality, major adverse kidney events (MAKEs), and major adverse cardiovascular events (MACEs) in patients with type 2 diabetes and AKD.Design, Setting, and ParticipantsThis cohort study used global health care data (the TriNetX database) spanning from September 30, 2002, to September 30, 2022. Propensity score matching was used to select a cohort of patients, and follow-up was conducted with a maximum duration of 5 years (completed on September 30, 2022) or until the occurrence of an outcome or death.InterventionThe use of SGLT-2is.Main Outcomes and MeasuresThe primary outcomes measured were mortality, MAKEs, and MACEs. Adjusted hazard ratios (AHR) with 95% CIs were calculated to compare the risks between SGLT-2i users and nonusers, representing the mean treatment effect among the treated patients.ResultsA total of 230 366 patients with AKD (mean [SD] age, 67.1 [16.4] years; 51.8% men and 48.2% women) were enrolled in the study, which had a median follow-up duration of 2.3 (IQR, 1.2-3.5) years. Among these, 5319 individuals (2.3%) were identified as SGLT-2i users. Among nonusers, the incidence of mortality was 18.7%, the incidence of MAKEs was 21.0%, and the incidence of MACEs was 25.8%. After propensity score matching, the absolute differences between SGLT-2i users and nonusers for incidence of mortality, MAKEs, and MACEs were 9.7%, 11.5%, and 12.3%, respectively. Based on the treated population, SGLT-2i use was associated with a significantly lower risk of mortality (AHR, 0.69 [95% CI, 0.62-0.77]), MAKEs (AHR, 0.62 [95% CI, 0.56-0.69]), and MACEs (AHR, 0.75 [95% CI, 0.65-0.88]) compared with nonuse. External validation using a multicenter cohort data set of 1233 patients with AKD patients who were SGLT-2i users confirmed the observed beneficial outcomes. Notably, the risk reduction associated with SGLT-2is remained significant even among patients without hypertension, those with advanced chronic kidney disease, and those not receiving other hypoglycemic agents.Conclusions and RelevanceIn this cohort study of patients with type 2 diabetes and AKD, administration of SGLT-2is was associated with a significant reduction in all-cause mortality, MAKEs, and MACEs when compared with nonuse, underscoring the importance of SGLT-2is in care after acute kidney injury. These findings emphasize the potential benefits of SGLT-2is in managing AKD and mitigating the risks of major cardiovascular and kidney diseases.

SGLT2i treatment during AKI and its association with major adverse kidney events

“…Similarly to what was reported in two other studies, SGLT2is seem to be safe, as they do not cause new AKI episodes ( Agarwal et al, 2022 ; Alkas et al, 2023 ). These relatively neutral effects contrast with the benefits reported by Pan et al (2024 ), where patients with diabetes who survived hospitalization with AKI and who were treated with SGLT2is in the first 90 days after being discharged had a reduction in cardiorenal events and death.…”

Biomarkers in pursuit of precision medicine for acute kidney injury: hard to get rid of customs

“…Isolated oliguria, even without an increase in sCr, is linked to higher mortality [ 45 ]. Despite efforts to enhance risk stratification for poor kidney outcomes using biomarkers like NGAL in oliguric patients [ 46 , 47 ], they did not surpass the predictive performance of sCr [ 48 ]. Distinctions in risk among episodes of oliguria were acknowledged, and NGAL successfully differentiated functional oliguria from AKI based on sCr criteria in a separate study [ 49 ].…”

Long-Term Mortality and SGLT2 Inhibitors in Type 2 Diabetes with and without Renal Impairment: An Observational Cohort Study

“…They can also include patients with comorbid conditions excluded from clinical trials, elderly patients, or patients on wide range of treatment regimens. Recently, a large cohort study demonstrated that SGLT2 was associated with mortality reduction and major adverse cardiovascular events among patients with type 2 diabetes and acute kidney disease [8].…”