Disclosures: Patorno reports being an investigator of an investigator-initiated grant to the Brigham and Women’s Hospital from Boehringer Ingelheim, not directly related to the topic of the submitted work. Please see the study for all other authors’ relevant financial disclosures.
December 03, 2021
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SGLT-2 inhibitors may prevent AKI in older adults with type 2 diabetes

Disclosures: Patorno reports being an investigator of an investigator-initiated grant to the Brigham and Women’s Hospital from Boehringer Ingelheim, not directly related to the topic of the submitted work. Please see the study for all other authors’ relevant financial disclosures.
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The initiation of SGLT-2 inhibitors correlated with a reduced risk of AKI in older adults with type 2 diabetes compared with other glucose-lowering medications.

According to data published in the American Journal of Kidney Diseases, SGLT-2 inhibitors (SGLT-2i) may prevent AKI events.

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“SGLT-2i have been found to have many benefits for patients with type 2 diabetes (T2D). However, whether SGLT-2i increase the risk of AKI remains unknown,” Elisabetta Patorno, MD, DrPH, associate professor of medicine in the division of pharmacoepidemiology and pharmacoeconomics in the department of medicine at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “We examined the association of AKI hospitalization with prior initiation of an SGLT-2i compared to initiation of a dipeptidyl peptidase 4 inhibitor (DPP-4i) or a glucagon-like peptide 1 receptor agonist (GLP-1RA) among older adults with T2D in routine practice.”

In a population-based, longitudinal cohort study, researchers observed adults at least 66 years old with T2D enrolled in Medicare and who were new users of SGLT-2i, DPP-4i or GLP-1RA agents in the interval between March 29, 2013, and Dec. 31, 2017.

Using propensity scores in two pairwise comparisons, 68,130 and 71,477 patients using SGLT-2i were 1:1 matched to patients using DPP-4i or GLP-1RA. The primary outcome of this study was hospitalization for AKI.

Analyses revealed the initiation of SGLT-2i correlated with an almost 30% reduction in the risk for AKI hospitalizations compared with DPP-4i and a nearly 20% reduction compared with GLP-1RA. Overall, the risk for AKI was lowest in the SGLT-2i group.

“Our study has important clinical implications. The latest clinical guidelines for the treatment of T2D recommend SGLT-2i, DPP-4i and GLP-1RA as second-line therapies for T2D following metformin failure or intolerance and suggest the choice among these medications should be based on patient-specific characteristics, eg, history of cardiovascular disease. Notably, T2D per se increases the risk of AKI by three[fold] to fivefold. Older age is also a significant risk factor for AKI. Therefore, a glucose-lowering medication reducing the risk of AKI would be advantageous for older adults,” Patorno and colleagues wrote. “Our study, which is based on a large population of routine care patients older than 65 years, provides reassurance on the safety of SGLT-2i with respect to the risk of AKI and suggests SGLT-2i may actually prevent AKI events compared to alternative diabetes treatments.”

The limitations of this study include the lack of laboratory results in the Medicare dataset, which kept researchers from matching patients for baseline serum creatinine and albuminuria levels.