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Kidney Week

Abstract: PO0262

Sodium-Glucose Cotransporter 2 Inhibitors and the Risk of AKI in Older Adults with Type 2 Diabetes

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Zhuo, Min, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
  • Paik, Julie M., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Wexler, Deborah J., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Bonventre, Joseph V., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Kim, Seoyoung C., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Patorno, Elisabetta, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
Background

We compared the association of AKI with the initiation of a sodium-glucose cotransporter-2 inhibitors (SGLT-2i) to the initiation of a dipeptidyl peptidase 4 inhibitor (DPP-4i) or a glucagon-like peptide 1 receptor agonist (GLP-1RA) in adults aged ≥ 66 years with type 2 diabetes (T2D).

Methods

In this nationwide cohort study, we used Medicare fee-for-service from 2013 to 2017 to identify older adults with T2D. SGLT-2i initiators were 1:1 propensity score (PS)-matched to DPP-4i or GLP-1RA initiators, in two pairwise comparisons. More than 100 variables were used in the PS model, including demographic characteristics, comorbid conditions, medication use, and health care utilization. The primary outcome was a hospital discharge diagnosis of AKI in the primary or secondary position. Cox proportional hazards regression models were used to generate hazard ratios (HRs) in PS-matched groups.

Results

A total of 68,130 and 71,477 SGLT-2i new users were PS-matched to new users of DPP-4i or GLP-1RA (Table), respectively. The risk of AKI was lower in the SGLT-2i group than the DPP-4i group (HR 0.71, 95% CI 0.65-0.76) or the GLP-1RA group (HR 0.81, 95% CI 0.75-0.87), over a median follow-up of 181 days.

Conclusion

Among older adults with T2D, initiating an SGLT-2i was associated with a reduced risk of AKI compared to initiation of a DPP-4i or GLP-1RA.

Table. Selected baseline characteristics of SGLT-2i versus DPP-4i and SGLT-2i versus GLP-1RA cohorts after PS-matching
CharacteristicSGLT-2i versus DPP-4i
(Cohort 1, n=68,130 pairs)
SGLT-2i versus GLP-1RA
(Cohort 2, n=71,477 pairs)
Age, mean (SD), years71.9 (5.1)71.8 (5.2)71.9 (5.1)71.9 (5.2)
Male34,244 (50.3%)34,157 (50.1%)33,174 (46.4%)33,190 (46.4%)
White56,252 (82.6%)56,245 (82.6%)59,366 (83.1%)59,070 (82.6%)
Acute kidney injury2,225 (3.3%)2,225 (3.3%)2,977 (4.2%)2,997 (4.3%)
Chronic kidney disease stages 3-55,525 (8.1%)5,498 (8.1%)8,237 (11.5%)8,306 (11.6%)
Hypertension62,857 (92.3%)62,760 (92.1%)66,464 (93.0%)66,512 (93.1%)
Diabetic nephropathy7,155 (10.5%)7,046 (10.3%)9,561 (13.4%)9,647 (13.5%)
Heart failure7,481 (11.0%)7,520 (11.0%)8,771 (12.3%)8,788 (12.3%)
Combined comorbidity index (CCI), mean (SD)1.2 (2.0)1.2 (2.0)1.5 (2.1)1.5 (2.1)
Metformin53,142 (78.0%)53,319 (78.3%)53,957 (75.5%)53,925 (75.4%)
Insulin19,153 (28.1%)18,988 (27.9%)22,904 (32.0%)22,818 (31.9%)
GLP-1RA (cohort 1) or DPP-4i (cohort 2)8,137 (11.9%)7,595 (11.1%)26,527 (37.1%)26,787 (37.5%)
Renin-angiotensin-aldosterone system (RAAS) inhibitors54,088 (79.4%)53,823 (79.0%)57,506 (80.5%)57,846 (80.9%)
Endocrinologist visit12,949 (19.0%)12,520 (18.4%)15,744 (22.0%)15,871 (22.2%)
Nephrologist visit2,955 (4.3%)2,947 (4.3%)4,280 (6.0%)4,341 (6.1%)

Characteristics were measured during the 365 days before treatment initiation, standardized differences < 0.1