Lower Risk of Acute Kidney Injury in Hospitalized Patients Treated with SGLT-2 Inhibitors: A Retrospective Matched...

Recent studies have shown possible protective effects of sodium-glucose co-transporter-2 inhibitors (SGLT-2is) for acute kidney injury (AKI). As SGLT-2is have diuretic properties, uncertainty remains regarding their effect on the risk of AKI during hospital admission, where hypovolemia frequently occurs. Therefore, we assessed the association between (pre)hospital treatment with SGLT-2i and AKI risk in hospitalized patients.

We performed a matched cohort study. We identified hospitalized patients with prehospital use of SGLT-2i in the Frisius Medical Centre Leeuwarden, between October 21, 2021, and February 12, 2024. These were matched 1:1 to hospitalized patients without prehospital use of SGLT-2i. AKI incidence was the main outcome. Second, SGLT-2i treatment during hospitalization was assessed.

Overall,1,054 hospital admissions were included, 527 with and 527 without prehospital SGLT-2i use. Overall, 34% of patients were women; the median age was 71 years (IQR 65-78). SGLT-2i was indicated for heart failure in 16%, chronic kidney disease 6%, type 2 diabetes 7%, and at least two indications in 72%. Hospital-acquired AKIs occurred in 17.5% admissions with prehospital SGLT-2i treatment and 25.8% among those without (RR = 0.68 [95% CI = 0.53-0.86]). AKI risk was similarly decreased in patients continuing SGLT-2i during hospital admission (RR 0.65 [0.49-0.85]). AKI was associated with increased length of hospital stay (median 7 days, IQR 4-11, versus 3 days, IQR 1-7 without AKI); SGLT-2i use was not. Overall, SGLT-2i treatment did not affect overall mortality. In patients with AKI, mortality was numerically lower in SGLT-2i patients (risk difference = 7.8%, 95% CI -0.9-15.7%), although the confidence interval includes zero.

We observed a 32% lower risk of AKI in hospitalized patients using SGLT-2i at admission. This suggest a protective effect of SGLT-2i against AKI, which remained when SGLT-2i was continued during hospitalization.