Sodium-glucose cotransport 2 inhibitors (SGLT2i) reduce the risks for major adverse cardiovascular and kidney events, including early mortality, in patients with type 2 diabetes and acute kidney disease, a new study finds.

In a propensity-score matched analysis, SGLT2i use was significantly associated with a 31% lower risk of all-cause mortality, a 38% lower risk of major adverse kidney events (MAKEs), and a 25% lower risk of major adverse cardiovascular events (MACEs) compared with nonuse in adjusted analyses, Vin-Cent Wu, MD, PhD, of the National Taiwan University Hospital in Taipei, and colleagues reported in JAMA Network Open. Risk reductions were even found among subgroups with advanced chronic kidney disease (CKD) — defined as an estimated glomerular filtration rate of 30 to 45 mL/min/1.73 m² —  and also in patients without hypertension, and those who did not use other hypoglycemic agents. MAKEs were defined as return to dialysis, dialysis dependence, or mortality. MACEs included cerebral infarction, hemorrhagic stroke, acute myocardial infarction, cardiogenic shock, or mortality.

The findings underscore the importance of SGLT2i use after acute kidney injury, Dr Wu’s team stated. Prevention and effective management of acute kidney disease is “vital to prevent further kidney damage and adverse outcomes.”

The study involved 5317 SGLT2i users matched to 5317 nonusers among 230,366 patients with acute kidney disease warranting in-hospital dialysis from the 2002-2022 TriNetX database.

Unmanaged acute kidney disease can lead to CKD. In a separate substudy of the EMPA-KIDNEY trial, published in the Journal of the American Society of Nephrology, investigators found that the SGLT2i empagliflozin (10 mg once daily) reduces absolute fluid overload in patients with CKD.

“Along with other mechanisms, this effect may contribute to the cardiovascular benefits of SGLT2 inhibitors,” William G. Herrington, PhD, of the University of Oxford Nuffield in Oxfordshire, United Kingdom, and colleagues wrote.

References

Pan HC, Chen JY, Chen HY, et al. Sodium-glucose cotransport protein 2 inhibitors in patients with type 2 diabetes and acute kidney disease. JAMA Netw Open. Published online January 3, 2024. doi:10.1001/jamanetworkopen.2023.50050

Mayne KJ, Staplin N, Keane DF, et al. Effects of empagliflozin on fluid overload, weight and blood pressure in chronic kidney disease. J Am Soc Nephrol. Published online December 12, 2023. doi:10.1681/ASN.0000000000000271