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

Key PointsPost-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.A minority of Veterans with diabetic kidney disease received a sodium-glucose cotransporter-2 inhibitor after having had AKI during the study period.BackgroundThe effect of sodium-glucose cotransporter-2 inhibitor (SGLT2i) on kidney function after AKI is unknown.MethodsThe 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 m²and ≥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.ResultsTen 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]).ConclusionsSGLT2i use was associated with a lower risk for CKD progression and for recurrent AKI among those with diabetic kidney disease and recent AKI.