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

Abstract

The effect of SGLT2i on kidney function after acute kidney injury (AKI) is unknown. 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 three months to <60 mL/minute/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 prior to 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/minute/1.73 m2. 10,036 Veterans met study inclusion criteria. 2,794 (28%) received a SGLT2i. 775 (8%) had CKD progression and 1,816 (18%) had recurrent AKI over a median follow-up of 1.8 and 1.7 years, respectively, which began one year after the index AKI hospitalization. SGLT2i use was associated with lower risk for CKD progression [adjusted hazard ratio (aHR) 0.72 (95% confidence interval (CI): 0.57-0.91)] and for recurrent AKI [aHR 0.75 (95% CI: 0.65-0.88)]. SGLT2i use was associated with a lower risk for CKD progression and for recurrent AKI among those with diabetic kidney disease and recent AKI.