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Risk of CKD among patients with DM taking diuretics or SGLT2i: a retrospective cohort study in Taiwan

Han-Jie Lin1, Pin-Yang Shih2, Stella Chin-Shaw Tsai1,3

  • 1Department of Otolaryngology, Tungs' Taichung MetroHarbor Hospital, 435, Taichung, Taiwan.

BMC Pharmacology & Toxicology
|March 5, 2024
PubMed

Insights

Diuretics may increase chronic kidney disease (CKD) risk in diabetic patients. However, combining diuretics with SGLT2 inhibitors offers protection against CKD progression.

Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic patients face long-term risks of chronic kidney disease (CKD) and declining renal function.
  • Understanding the impact of common medications like diuretics and SGLT2 inhibitors on these risks is crucial.

Purpose of the Study:

  • To evaluate the long-term risk of CKD and renal function decline in diabetic patients using diuretics and SGLT2 inhibitors.
  • To compare the risks associated with diuretics alone, SGLT2 inhibitors alone, and their combination.

Main Methods:

  • Utilized data from the National Health Insurance Research Database (NHIRD) for patients with diabetes mellitus (DM).
  • Defined SGLT2 inhibitor (SGLT2i) and non-SGLT2i cohorts based on medication use.
  • Employed propensity score matching (1:1) to control for age, sex, index date year, and comorbidities.

Main Results:

  • Diuretics-only use was associated with a significantly higher risk of CKD (aHR, 2.46) compared to no SGLT2i or diuretics.
  • Both SGLT2i and diuretics, and SGLT2i alone, showed lower CKD risks (aHR, 0.45 and 0.26, respectively) than diuretics-only.
  • SGLT2i alone had a lower risk (aHR, 0.58) than the combination of SGLT2i and diuretics.

Conclusions:

  • Diuretics monotherapy may elevate CKD risk in diabetic individuals.
  • Combination therapy with SGLT2 inhibitors and diuretics provides protection against CKD.
  • SGLT2 inhibitors appear to mitigate the potential adverse effects of diuretics on renal health in diabetes.
Abstract

Keywords:
Chronic kidney disease (CKD)DiureticsNational Health Insurance Research Database (NHIRD).Sodium-glucose cotransporter-2 inhibitors (SGLT2i)

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