Sodium-Glucose Transport Protein 2 Inhibitor Use for Type 2 Diabetes and the Incidence of Acute Kidney Injury in Taiwan
Authors' conclusion
The study findings suggest that patients with T2D who receive SGLT2i may have lower risk of AKI and AKI-D compared with those who receive DPP4i.
Study context
- Population
- Patients with T2D treated with SGLT2is or DPP-4is between May 2016 and December 2018, National Health Insurance Research Database, Taiwan; 44.1% female, mean (SD) age 58 (12) yearspropensity score-matched
- Participants
- 104,462 patients
- Exposure
- SGLT2i vs DPP-4i
- Outcome
- Incidence of AKI and AKI requiring dialysis (AKI-D)
- Follow-up
- During the study period ( ≈2.50 years)
Methodological detailsnationwide, propensity score-matched, Analysis conducted between October 15, 2021, and January 30, 2022
- Nationwide
- Propensity score-matched
- Analysis conducted between October 15, 2021, and January 30, 2022
Main finding
As reported in the abstract
AKI and AKI-D · follow-up approximately 2.50 years
Risk (acute kidney injury (AKI))
0.66
95% CI 0.57–0.75P < 0.001
0.66-fold risk for AKI
Risk (AKI-D)
0.56
95% CI 0.37–0.84P = 0.005
0.56-fold risk of AKI-D
- AKI, all participants
- 856 (0.8%)
- AKI-D, all participants
- 102 (<0.1%)
Observational data: associations, not effects.
Further findings
| Outcome | Estimate | P value | |
|---|---|---|---|
| AKI with concomitant diseasesSGLT2ivs DPP4i | HR (AKI with respiratory failure) 0.42 (95% CI 0.26–0.69) | P < 0.001 | |
| AKI with concomitant diseasesSGLT2ivs DPP4i | HR (AKI with shock) 0.48 (95% CI 0.23–0.99) | P = 0.048 | |
| AKI with concomitant diseasesSGLT2ivs DPP4i | HR (AKI with heart disease) 0.79 (95% CI 0.58–1.07) | P = 0.13 | |
| AKI with concomitant diseasesSGLT2ivs DPP4i | HR (AKI with sepsis) 0.77 (95% CI 0.58–1.03) | P = 0.08 | |
| 0.20.5125Ratio (log scale) |
| Outcome | Difference in incidence | P value |
|---|---|---|
| Advanced CKD (stage 4 and 5) after AKI · 90 daysLower with SGLT2i; 23 of 352 patients | 6.53% | P = 0.045 |
- AKI with concomitant diseases — AKI with heart disease
- 80 (22.73%)
- AKI with concomitant diseases — AKI with sepsis
- 83 (23.58%)
- AKI with concomitant diseases — AKI with respiratory failure
- 23 (6.53%)
- AKI with concomitant diseases — AKI with shock
- 10 (2.84%)
Original publication
Sodium-Glucose Transport Protein 2 Inhibitor Use for Type 2 Diabetes and the Incidence of Acute Kidney Injury in Taiwan. JAMA Netw Open. Published 1 February 2023. doi:10.
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