Acute Kidney Injury Events in Patients With Type 2 Diabetes Using SGLT2 Inhibitors Versus Other Glucose-Lowering...

Area of Science:

• Nephrology
• Cardiology
• Endocrinology

Background:

• Sodium/glucose cotransporter 2 (SGLT2) inhibitors are recognized for slowing chronic kidney disease progression and preventing heart failure.
• However, concerns exist regarding a potential increased risk of acute kidney injury (AKI) with SGLT2 inhibitor use.

Purpose of the Study:

• To evaluate the association between SGLT2 inhibitor use and the incidence of AKI.
• To compare AKI rates in patients with type 2 diabetes initiating SGLT2 inhibitors versus other glucose-lowering drugs (oGLDs).

Main Methods:

• A retrospective cohort study was conducted using a province-wide prescription database in Manitoba, Canada (June 2014–March 2017).
• Adults with type 2 diabetes initiating SGLT2 inhibitors or oGLDs were identified.
• Propensity score matching and cause-specific hazards models were employed to compare AKI rates, with sensitivity analyses including intention-to-treat and new-user designs.

Main Results:

• The study compared 4,778 incident users of SGLT2 inhibitors with 4,778 matched incident users of oGLDs.
• No significant difference in the primary outcome of AKI was observed between the SGLT2 inhibitor group and the oGLD group (HR, 0.64; 95% CI, 0.40-1.03; P = 0.06) using an on-treatment approach.
• Sensitivity analyses did not reveal an increased risk of AKI associated with SGLT2 inhibitors.

Conclusions:

• In a real-world, population-based cohort of patients with type 2 diabetes, SGLT2 inhibitors were not associated with a higher risk of acute kidney injury compared to other glucose-lowering drugs.
• These findings suggest that SGLT2 inhibitors can be safely used in this patient population regarding AKI risk.