Acute renal outcomes with sodium‐glucose co‐transporter‐2 inhibitors: Real‐world data analysis. Issue 2 (15th October 2018) - Cahn, Avivit
Abstract : Aim: To assess the possible risk of acute kidney injury (AKI) with the use of sodium‐glucose co‐transporter‐2 inhibitors (SGLT2‐i) as well as changes in estimated glomerular filtration rate (eGFR), hospitalizations and mortality in a real‐world setting. Materials and methods: Included in this historical cohort study were patients with type 2 diabetes in a large health organization in Israel who initiated therapy with SGLT2‐i or dipeptidyl peptidase‐4 inhibitors (DPP‐4i) during 1 April 2015 to 30 June 2017. We collected data on serum creatinine measurements taken between 180 days prior to and 24 weeks after therapy initiation. Study endpoints included ≥30% reduction in eGFR, hospitalization with AKI, any hospitalization and all‐cause mortality. Results: Overall 6418 and 5604 patients initiated SGLT2‐i and DPP‐4i, respectively. Baseline mean (SD) eGFR was higher among the SGLT2‐i group compared with the DPP‐4i group (88.3 [17.4] and 82.8 [23.7], respectively) but were similar when stratifying by chronic kidney disease (CKD) stages. The adjusted odds ratio (OR) (95% confidence interval [CI]) for ≥30% reduction in eGFR with SGLT2‐i versus DPP4‐i was 0.70 (0.49‐1.00) and ORs ranged from 1.97 (0.62‐6.26) to 0.45 (0.21‐0.99) in patients with baseline eGFR 30 to 45 and ≥90 mL/min/1.73 m 2, respectively. Risks of AKI (OR = 0.47, 95% CI 0.27‐0.80), hospitalization (OR = 0.66, 95% CI 0.56‐0.78) or all‐cause mortality (OR = 0.43, 95% CI 0.20‐0.95) were lower in patients initiating SGLT2‐i versus DPP‐4i. Conclusions: This real‐world data analysis supports reassuring findings from previous randomized clinical trials showing no increased AKI risk among SGLT2‐i users. Nevertheless, because of the more prominent decrease in eGFR in patients with moderate CKD, cautious use of SGLT2‐i in patients with reduced eGFR is advised.