No increased AKI risk for SGLT2 inhibitors in real-world setting
medwireNews: Real-world study data confirm that sodium glucose cotransporter (SGLT)2 inhibitors do not significantly increase the risk for acute kidney injury (AKI) compared with dipeptidyl peptidase (DPP)-4 inhibitors among patients with type 2 diabetes.
However, patients who received SGLT2 inhibitors, particularly those with progressive chronic kidney disease (CKD), experienced a more prominent decline in estimated glomerular filtration rate (eGFR) immediately after treatment initiation than patients who received DPP-4 inhibitors.
This suggests that “cautious use of SGLT2 [inhibitors] in patients with reduced eGFR is advised,” remark Avivit Cahn (Hadassah Hebrew University Hospital, Jerusalem, Israel) and co-authors.
The retrospective cohort study included over 12,000 patients with type 2 diabetes who began treatment with SGLT2 inhibitors (n=6418) or DPP-4 inhibitors (n=5604) between 2015 and 2017.
As reported in Diabetes, Obesity and Metabolism, patients treated with SGLT2 inhibitors were less likely to experience a reduction in eGFR of at least 30% in the first 24 weeks than those treated with DPP-4 inhibitors, at 1.2% versus 1.6%, but the adjusted odds ratio (aOR; 0.70) was of borderline significance.
Of note, during the initial few weeks of treatment, there were significantly greater declines in eGFR among patients receiving SGLT2 inhibitors than among those receiving DPP-4 inhibitors, particularly for those whose baseline eGFR was at or below 60 mL/min per 1.73 m2.
In spite of this, significantly fewer patients in the SGLT2 group were hospitalized with AKI compared with those in the DPP-4 group, at 0.4% versus 1.4% and an aOR of 0.47.
Furthermore, subgroup analysis showed that there was no increased risk for AKI with SGLT2 inhibitors at any CKD stage.
There were also significantly fewer hospitalizations for any cause (aOR=0.66) or deaths (aOR=0.43) with SGLT2 inhibitors than with DPP-4 inhibitors.
Cahn et al conclude: “This real-world data analysis supports reassuring findings from previous randomized clinical trials demonstrating no increased AKI risk among SGLT2 [inhibitor] users.”
By Laura Cowen
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