SGLT2 Inhibitors and Long-Term Outcomes After AKI

Area of Science:

• Nephrology
• Cardiorenal Medicine
• Clinical Trials

Background:

• Post-acute kidney injury (AKI) survivors face high risks for adverse renal and non-renal outcomes.
• No specific treatments are currently available for this vulnerable patient group.

Purpose of the Study:

• To investigate the efficacy of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing major adverse kidney events (MAKE365) at one year in severe AKI survivors.
• To assess the impact of empagliflozin on recurrent AKI in the post-AKI setting.

Main Methods:

• A multicenter randomized controlled trial involving 200 severe AKI survivors with eGFR ≥ 20 ml/min.
• Participants received either empagliflozin 10 mg/d or placebo for one year.
• The primary outcome was MAKE365, a composite of persistent kidney dysfunction, need for long-term dialysis, or death.

Main Results:

• Empagliflozin did not significantly reduce MAKE365 compared to placebo (35% vs. 36%, P=0.82).
• A significant reduction in recurrent AKI was observed in the empagliflozin group (IRR: 0.51, P=0.008).
• AKI stage 3 was predominant, with a substantial proportion requiring renal replacement therapy.

Conclusions:

• Empagliflozin did not meet the primary endpoint of reducing MAKE365 in severe AKI survivors.
• Empagliflozin demonstrated a significant benefit in reducing the incidence of recurrent AKI.
• Further research may explore SGLT2i for preventing AKI recurrence in high-risk patients.