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

Heng-Chih Pan1,2,3,4, Jui-Yi Chen5,6, Hsing-Yu Chen7,8,9

  • 1Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei.

JAMA Network Open
|January 3, 2024
PubMed
Abstract

Insights

Sodium-glucose cotransport protein 2 inhibitors (SGLT-2is) significantly reduced mortality, major adverse kidney events (MAKEs), and major adverse cardiovascular events (MACEs) in patients with type 2 diabetes and acute kidney disease (AKD). This highlights SGLT-2is as crucial for AKD care.

Area of Science:

  • Nephrology and Endocrinology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Sodium-glucose cotransport protein 2 inhibitors (SGLT-2is) show benefits in type 2 diabetes for kidney and cardiovascular outcomes.
  • The impact of SGLT-2is on patients with acute kidney disease (AKD) and type 2 diabetes is not well-established.

Purpose of the Study:

  • To investigate the long-term effects of SGLT-2is on mortality, major adverse kidney events (MAKEs), and major adverse cardiovascular events (MACEs).
  • To assess the association of SGLT-2is with outcomes in patients diagnosed with AKD and type 2 diabetes.

Main Methods:

  • A large-scale cohort study utilizing the TriNetX global health care database (2002-2022).
  • Propensity score matching was employed to create comparable groups of SGLT-2i users and nonusers.
  • Outcomes including mortality, MAKEs, and MACEs were tracked for up to 5 years post-AKD diagnosis.

Main Results:

  • The study included 230,366 patients with AKD; 2.3% were SGLT-2i users.
  • SGLT-2i use was associated with a significant reduction in mortality (AHR, 0.69), MAKEs (AHR, 0.62), and MACEs (AHR, 0.75) compared to nonuse.
  • Benefits were observed across subgroups, including those without hypertension and with advanced chronic kidney disease.

Conclusions:

  • SGLT-2is significantly decrease mortality, MAKEs, and MACEs in patients with type 2 diabetes and AKD.
  • These findings support the integration of SGLT-2is into the management of AKD.
  • SGLT-2is demonstrate potential in mitigating long-term cardiovascular and kidney risks following acute kidney injury.

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