Comorbid conditions, concomitant diuretic use up AKI risk after SGLT2i treatment in diabetics

Among patients with type 2 diabetes (T2D), the risk of acute kidney injury (AKI) after sodium-glucose co-transporter 2 inhibitor (SGLT2i) treatment is higher in men, older adults, and those with low body mass index (BMI), chronic heart failure, and concomitant diuretic use, a study has found.

The researchers performed a retrospective analysis of 171,622 T2D patients who had been administered SGLT2is. Participant data were retrieved from Japan’s Medical Data Vision administrative claims database and screened for pertinent information, such as AKI diagnosis, underlying cardiovascular diseases and risks, and medications taken.

A total of 476 patients developed AKI during the observation period, yielding an incidence rate of 0.3 percent. Adjusted Cox proportional hazards analysis revealed that men were nearly 50-percent more likely to develop AKI than women (hazard ratio [HR], 1.43, 95 percent confidence interval [CI], 1.16–1.75; p=0.001).

SGLT2i medication likewise significantly elevated AKI risk among T2D patients who were ≥65 years of age (vs <65 years; HR, 1.58, 95 percent CI, 1.29–1.93; p<0.001) and those who had BMI <25 kg/m² (vs ≥25 kg/m²; HR, 1.41, 95 percent CI, 1.61–1.64; p<0.001).

In terms of comorbidities, both chronic heart failure (HR, 1.71, 95 percent CI, 1.38–2.11; p<0.001) and stroke (HR, 1.78, 95 percent CI, 1.20–2.61; -p=0.004) emerged as significant risk factors for AKI. Concomitant use of diuretics had a similar effect (HR, 2.80, 95 percent CI, 2.26–3.46; p<0.001).

“To minimize AKI onset, clinical features should be thoroughly evaluated before initiating SGLT2i administration. We hope to investigate other drugs expected to increase the AKI risk when used concomitantly with SGLT2is,” the researchers said.