A cohort study of sodium-glucose cotransporter-2 inhibitors after acute kidney injury among Veterans with diabetic kidney disease.

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  • Additional Information
    • Source:
      Publisher: Elsevier Country of Publication: United States NLM ID: 0323470 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1523-1755 (Electronic) Linking ISSN: 00852538 NLM ISO Abbreviation: Kidney Int Subsets: MEDLINE
    • Publication Information:
      Publication: 2016- : New York : Elsevier
      Original Publication: New York, Springer-Verlag.
    • Subject Terms:
      Sodium-Glucose Transporter 2 Inhibitors*/therapeutic use ; Sodium-Glucose Transporter 2 Inhibitors*/adverse effects ; Acute Kidney Injury*/mortality ; Acute Kidney Injury*/chemically induced ; Diabetic Nephropathies*/mortality ; Diabetic Nephropathies*/drug therapy ; Diabetic Nephropathies*/complications ; Diabetic Nephropathies*/etiology ; Veterans*/statistics & numerical data ; Diabetes Mellitus, Type 2*/drug therapy ; Diabetes Mellitus, Type 2*/complications ; Diabetes Mellitus, Type 2*/mortality ; Diabetes Mellitus, Type 2*/blood; Humans ; Male ; Female ; Retrospective Studies ; Middle Aged ; Aged ; United States/epidemiology ; Time Factors ; Creatinine/blood ; Proteinuria/mortality ; Proteinuria/drug therapy ; Risk Factors ; Hospitalization/statistics & numerical data
    • Abstract:
      Sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce the risk for several adverse outcomes among patients with diabetic kidney disease. Yet, optimal timing for SGLT2i after acute kidney injury (AKI) is uncertain, as are the providers responsible for post-AKI SGLT2i initiation. Using a retrospective cohort of United States Veterans with diabetes mellitus type 2 and proteinuria, we examined encounters by provider specialty before SGLT2i initiation and subsequent all-cause mortality after hospitalization with AKI, defined by a 50% or more rise in serum creatinine. Covariates included recovery, defined by return to a 110% or less of baseline creatinine, and time since AKI hospitalization. Among 21,330 eligible Veterans, 7,798 died (37%) and 6,562 received a SGLT2i (31%) over median follow-up of 2.1 years. Post-AKI SGLT2i use was associated with lower mortality risk [adjusted hazard ratio 0.63 (95% confidence interval 0.58-0.68)]. Compared with neither SGLT2i use nor recovery, mortality risk was similar with recovery without SGLT2i use [0.97 (0.91-1.02)] but was lower without recovery prior to SGLT2i use [0.62 (0.55-0.71)] and with SGLT2i use after recovery [0.60 (0.54-0.67)]. Finally, the effect of SGLT2i was stable over time (P for time-interaction 0.19). Thus, we observed reduced mortality with SGLT2i use after AKI among Veterans with diabetic kidney disease whether started earlier or later or before or after observed recovery. Hence, patients with diabetic kidney disease who receive a SGLT2i earlier after AKI experience no significant harm impacting mortality and experience a lower mortality risk than those who do not.
      (Copyright © 2024 International Society of Nephrology. All rights reserved.)
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    • Grant Information:
      UL1 TR002494 United States TR NCATS NIH HHS
    • Contributed Indexing:
      Keywords: acute kidney injury; diuretics; sodium-glucose cotransporter-2 inhibitors
    • Accession Number:
      0 (Sodium-Glucose Transporter 2 Inhibitors)
      AYI8EX34EU (Creatinine)
    • Publication Date:
      Date Created: 20240430 Date Completed: 20240621 Latest Revision: 20240710
    • Publication Date:
      20240710
    • Accession Number:
      PMC11193640
    • Accession Number:
      10.1016/j.kint.2024.03.026
    • Accession Number:
      38685561