Kidney Outcomes with Sodium-Glucose Cotransporter-2 Inhibitor Initiation after AKI among Veterans with Diabetic Kidney Disease

Abstract

Key Points:

1. Post-AKI sodium–glucose cotransporter-2 inhibitor use was associated with a reduced risk for progression of CKD and for recurrent AKI among veterans with diabetic kidney disease even after accounting for recovery from the index AKI.

2. A minority of Veterans with diabetic kidney disease received a sodium–glucose cotransporter-2 inhibitor after having had AKI during the study period.

Background: The effect of sodium–glucose cotransporter-2 inhibitor (SGLT2i) on kidney function after AKI is unknown.

Methods: The study population was drawn from a retrospective cohort of Veterans with diabetes mellitus type 2 (DM2) and proteinuria. The study exposure was time-varying use of SGLT2i after an index AKI hospitalization. The two study outcomes were time to (1) a sustained decrease in eGFR over at least 3 months to <60 ml/min per 1.73 m² and ≥30% below a post-AKI–updated eGFR and (2) recurrent hospitalization with AKI. AKI was defined as a rise in serum creatinine concentration to ≥50% above a moving outpatient creatinine baseline. DM2 was defined by ≥2 billing codes related to DM2 before the index AKI; proteinuria was defined by the most recent albuminuria, proteinuria, or urinalysis test. Veterans were required to have a baseline eGFR and an eGFR 3–12 months after the index AKI hospitalization ≥30 ml/min per 1.73 m².

Results: Ten thousand thirty-six Veterans met study inclusion criteria. Two thousand seven hundred and ninety-four (28%) received a SGLT2i. Seven hundred and seventy-five (8%) had CKD progression, and 1816 (18%) had recurrent AKI over a median follow-up of 1.8 and 1.7 years, respectively, which began 1 year after the index AKI hospitalization. SGLT2i use was associated with lower risk for CKD progression (adjusted hazard ratio 0.72 [95% confidence interval, 0.57 to 0.91]) and for recurrent AKI (adjusted hazard ratio 0.75 [95% confidence interval, 0.65 to 0.88]).

Conclusions: SGLT2i use was associated with a lower risk for CKD progression and for recurrent AKI among those with diabetic kidney disease and recent AKI.