Sodium-glucose cotransporter-2 inhibitors and risk of acute kidney injury in type 2 diabetes and chronic kidney disease: Nationwide target trial emulation
Main finding · AKI occurrenceResult — go to the resultAdjusted hazard ratio 0.74 95% CI 0.50–1.10Authors' conclusion
SGLT2i initiation was not associated with higher 90-day AKI risk than DPP-4i initiation in patients with T2DM and CKD. However, findings in certain high-risk subgroups remain uncertain and warrant further study.
Study context
- Population
- Adults aged ≥30 years with T2DM and chronic kidney disease (CKD) initiating SGLT2i or DPP-4i during 2016–2023
- Participants
- 43,502 new users
- Comparison
- Sodium-glucose cotransporter 2 inhibitors (SGLT2i) versus dipeptidyl peptidase-4 inhibitors (DPP-4i)
- SGLT2in = 8,253
- DPP-4in = 35,249reference
- Outcome
- AKI occurrence
- Follow-up
- 90-day
Methodological detailsSouth Korean claims data (2015-2024), Inverse probability of treatment weighting, weighted Cox models, Pre-specified subgroup and sensitivity analyses
- South Korean claims data (2015-2024)
- Inverse probability of treatment weighting
- Weighted Cox models
- Pre-specified subgroup and sensitivity analyses
Main finding
As reported in the abstract
Adjusted hazard ratio
0.74
95% CI 0.50–1.10
By group
SGLT2i
10.5 per 100,000 person-days
weighted incidence rate
DPP-4i
15.6 per 100,000 person-days
weighted incidence rate
SGLT2ivs DPP-4i
aHR 0.74 (95% CI 0.50–1.10)
Further findings
Subgroup analyses
- Subgroup findings were generally consistent, including among older adults; however, estimates for prior acute kidney injury (AKI) and advanced CKD had wide confidence intervals (CIs)
Original publication
Sodium-glucose cotransporter-2 inhibitors and risk of acute kidney injury in type 2 diabetes and chronic kidney disease: Nationwide target trial emulation. Diabetes Res Clin Pract. Published 12 November 2026. doi:10.
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