Impact of SGLT2 inhibitors on acute kidney injury

  • Menne J & al.
  • PLoS Med
  • 1 Dec 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that sodium-glucose cotransporter-2 inhibitors (SGLT2is) may lower the odds for acute kidney injury (AKI) in patients with diabetes mellitus.

Why this matters

  • Findings indicate that fear of causing AKI should not stop practitioners prescribing SGLT2is.

Study design

  • Systematic review and meta-analysis of 112 randomised trials (n=96,777) and 5 observational cohorts (n=83,934).
  • The effect of SGLT2-inhibitors on renal adverse events (AEs) was assessed (most patients had type 2 diabetes).
  • Funding: None.

Key results

  • Overall, 41 trials identified 1089 AKI AEs.
  • 410 AKI-related serious AEs (SAEs) were reported in 30 randomised trials (n=58,181).
  • SGLT2is diminished the odds for an SAE AKI by 36% (OR, 0.64; P<.001 dapagliflozin p and empagliflozin had comparable effect size.>
  • The number of AKI events noted in SGLT2i (n=38,441) vs placebo (n=29,718) arm: 550 vs 539 events.
  • Overall, SGLT2is had a positive effect, with an odds reduction of 25% (OR, 0.75; P<.001 with no detectable heterogeneity.>
  • Volume-depletion-related AEs were more common in the SGLT2i-treated patients (OR, 1.20; P<.001>
  • A positive effect of SGLT2is on adverse renal events was also noted from observational studies (OR, 0.40; P<.001>

Limitations

  • The safety endpoints were not validated by an endpoint committee.
  • Some studies may have under-reported AKI events.