Identification of risk factors associated with acute kidney injury in patients taking sodium-glucose cotransporter-2 inhibitors


Introduction: Studies have demonstrated that sodium-glucose cotransporter-2 (SGLT2) inhibitors are kidney protective; however, their ability to cause hemodynamic changes may predispose patients to acute kidney injury (AKI). A United States Food and Drug Administration warning recommends evaluating for factors that predispose patients to AKI before initiating a SGLT2 inhibitor.

Objective: To identify risk factors that may predispose persons with diabetes to AKI when initiating SGLT2 inhibitor therapy.

Methods: This was a multi-center retrospective cohort chart review of patients with type 2 diabetes prescribed a SGLT2 inhibitor from January 2013 to September 2019. Patients were included if they were receiving care at Advocate Medical Group and were confirmed to have taken one of the four SGLT2 inhibitors available at the time of study approval, canagliflozin, dapagliflozin, empagliflozin, or ertugliflozin, for at least 7 days. Patients were excluded if they did not have a basic metabolic panel or comprehensive metabolic panel recorded 1 year prior to or 6 months after SGLT2 inhibitor therapy initiation.

Results: Data extraction from the electronic medical record identified 6425 patients receiving a SGLT2 inhibitor, of which 1962 met inclusion criteria and were included for analysis. Thirty-five (1.8%) patients experienced an AKI after SGLT2 inhibitor therapy initiation. There was no statistically significant difference between groups based on background medication use (p = 0.325). At baseline, patients experiencing an AKI after SGLT2 inhibitor initiation were more likely to be older in age (p=0.010), have a higher serum potassium (p< 0.001), blood glucose (p=0.018), SCr (p=0.009) and UACR (p

Conclusions: The transient eGFR decline with SGLT2 inhibitor initiation should be expected and is generally not an indication to discontinue therapy. Future initiatives should be directed at increasing knowledge of monitoring recommendations for these agents.

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