Type 2 diabetes patients treated with or without SGLT-2 inhibitors were followed for about one year. In the Mount Sinai cohort, authors found that acute kidney injury (AKI) was 60% less common in those receiving SGLT-2 inhibitors than nonusers. On the secon (Geisinger) cohort, adjusted AKI risk was no different among the two experimental groups. All SGLT-2 inhibitors were included in the study; invokana, farxiga and jardiance.

Authors conclude that in a real-world setting, unlike the FDA warning, decreased renal sodium-glucose co-transporting does not cause acute kidney injury in patients with type 2 diabetes.

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Diabetes Care

Observational

August 2017

Objective: SGLT2 inhibitors are new medications that improve cardiovascular and renal outcomes in patients with type 2 diabetes. However, the Food and Drug Administration has issued alerts regarding increased acute kidney injury (AKI) risk with canagliflozin and dapagliflozin. We aimed to assess the real-world risk of AKI in new SGLT2 inhibitor users in two large health care utilization cohorts of patients with T2D.

Research Design and Methods: We used longitudinal data from the Mount Sinai chronic kidney disease registry and the Geisinger Health System cohort. We selected SGLT inhibitor users and nonusers (patients with T2D without SGLT2 inhibitor prescription). We determined AKI by the KDIGO definition (AKIKDIGO). We performed 1:1 nearest-neighbor propensity matching and calculated unadjusted hazard ratios (HRs) and adjusted HRs (aHRs; accounting for covariates poorly balanced) for AKI in primary and sensitivity analyses.

Results:

We identified 377 SGLT2 inhibitor users and 377 nonusers in the Mount Sinai cohort, of whom 3.8 and 9.7%, respectively, had an AKIKDIGO event over a median follow-up time of 14 months.

The adjusted and unadjusted hazards of AKIKDIGO were 60% lower in users (aHR and HR were 0.4, p = 0.01). 

Similarly, we identified 1,207 SGLT2 inhibitor users and 1,207 nonusers in the Geisinger cohort, of whom 2.2 and 4.6% had an AKIKDIGO event.

AKIKDIGO unadjusted hazards were lower in users (HR 0.5, p< 0.01) with modest attenuation postadjustment for covariates (aHR 0.6, p = 0.09).These estimates did not qualitatively change across several sensitivity analyses.

Conculisions:

Our findings do not suggest an increased risk of AKI associated with SGLT2 inhibitor use in patients with T2D in two large health systems.