SGLT2 Inhibitors and Long-Term Outcomes After AKI

Currently, there is no specific treatment for post-acute kidney injury (AKI) survivors, one of the highest risk groups of the renal and nonrenal adverse long-term outcomes. This study aimed to determine whether the sodium-glucose cotransporter-2 inhibitor (SGLT2i) can decrease 1-year major adverse kidney events (MAKE365) in post-AKI setting.

Multicenter randomized controlled trial, involving severe AKI survivors from 3 tertiary care hospitals, who were dialysis independent, and had an estimated glomerular filtration rate (eGFR) ≥ 20 ml/min per 1.73 m². The participants were randomized to receive empagliflozin 10 mg/d or matching placebo for 1 year after the incident AKI. The primary outcome was MAKE365, defined as a composite of persistent kidney dysfunction (a sustained decrease in eGFR ≥ 25% or increase in serum creatinine ≥ 200% of baseline), the need for long-term dialysis, or death at 1 year after the incident of AKI.

A total of 200 participants were included in this study, 98 patients in empagliflozin group and 102 patients in placebo group; AKI stage 3 was predominant, with renal replacement therapy required for 30% and 23% of patients in each group, respectively. On modified intention-to-treat analysis, MAKE365 occurred in 35% in the empagliflozin group and 36% in the placebo group (P = 0.82). The incident rate ratio indicated a significant reduction in recurrent AKI in the empagliflozin group (34 vs. 66 per 100 person-years, respectively; incident rate ratio: 0.51, 95% confidence interval [CI]: 0.31-0.84; P = 0.008).

Empagliflozin could not show reduction in MAKE365 but showed potential benefits in reducing recurrent AKI.