The following is a summary of “A cohort study of sodium-glucose cotransporter-2 inhibitors after acute kidney injury among Veterans with diabetic kidney disease,” published in the July 2024 issue of Nephrology by Murphy et al.
Patients with diabetic kidney disease often use sodium-glucose cotransporter-2 inhibitors (SGLT2i) to reduce the risk of several adverse outcomes. However, no defined timing for initiating SGLT2i after acute kidney injury (AKI) or determining which provider must initiate it post-AKI.
Researchers conducted a retrospective study analyzing encounters by provider specialty before starting SGLT2i and the subsequent all-cause mortality after AKI hospitalization in a cohort of U.S. veterans with type 2 diabetes and proteinuria.
They studied 21,330 U.S. veterans with type 2 diabetes and proteinuria and tracked the encounters by provider specialty before starting SGLT2i. The resulting all-cause mortality after an AKI hospitalization, defined by a 50% or more rise in serum creatinine, was also analyzed. Covariates included recovery, marked by a return to 110% or less of baseline creatinine, and the time since AKI hospitalization. Over a median follow-up of 2.1 years, 7,798 veterans died (37%) from the eligible 21,330, and 6,562 started SGLT2i (31%).
The results showed that using SGLT2i after AKI was linked to a lower risk of death [aHR 0.63 (95% CI: 0.58-0.68)]. Compared with neither SGLT2i nor recovery, mortality risk was similar with recovery but no SGLT2i use [0.97 (0.91-1.02)]. The risk was lower without recovery before starting SGLT2i [0.62 (0.55-0.71)] and with SGLT2i use after recovery [0.60 (0.54-0.67)]. The effect of SGLT2i was consistent over time (P for time-interaction 0.19).
Investigators concluded that starting SGLT2i after AKI in veterans with diabetic kidney disease lowers mortality, whether started early or late and doesn’t harm outcomes. Using SGLT2i early after AKI is better than not using it at all.
Source: kidney-international.org/article/S0085-2538(24)00309-0/fulltext#%20
