Lower Risk of Acute Kidney Injury in Hospitalized Patients Treated With SGLT-2 Inhibitors: A Retrospective Matched Cohort Study

BACKGROUND: Recent studies have shown possible protective effects of sodium-glucose co-transporter-2 inhibitors (SGLT-2i) for acute kidney injury (AKI). As SGLT-2i have diuretic properties, uncertainty remains regarding their effect on the risk of AKI during hospital admission, where hypovolemia frequently occurs. Therefore, we assessed the association between (pre)hospital treatment with SGLT-2i and AKI risk in hospitalized patients. METHODS: We performed a matched cohort study. We identified hospitalized patients with prehospital use of SGLT-2i in the Frisius Medical Centre Leeuwarden, between October 21, 2021, and February 12, 2024. These were matched 1:1 to hospitalized patients without prehospital use of SGLT-2i. AKI incidence was the main outcome. Secondly, SGLT-2i treatment during hospitalization was assessed. RESULTS: 1054 hospital admissions were included, 527 with and 527 without prehospital SGLT-2i use. 34% of patients were women, the median age was 71 years (IQR 65-78). SGLT-2i was indicated for heart failure in 16%, chronic kidney disease 6%, type 2 diabetes 7%, and at least two indications in 72%. Hospital-acquired AKIs occurred in 17.5% admissions with prehospital SGLT-2i treatment and 25.8% among those without (RR = 0.68 (95%CI = 0.53 to 0.86)). AKI risk was similarly decreased in patients continuing SGLT-2i during hospital admission (RR 0.65 (0.49 - 0.85)). AKI was associated with increased length of hospital stay (median 7 days, IQR 4-11, versus 3 days, IQR 1-7 without AKI), SGLT-2i use was not. Overall, SGLT-2i treatment did not affect overall mortality. In patients with AKI, mortality was numerically lower in SGLT-2i patients (Risk Difference = 7.8%, 95% CI -0.9 to 15.7%), although the confidence interval includes zero. CONCLUSION: We observed a 32% lower risk of AKI in hospitalized patients using SGLT-2i at admission. This suggest a protective effect of SGLT-2i against AKI, which remained when SGLT-2i was continued during hospitalization.