Abstract: FR-PO0074
SGLT2 Inhibitors and GLP-1 Receptor Agonists and the Risk for Adverse Outcomes After AKI or Acute Kidney Disease: Systematic Review and Meta-Analysis
Session Information
- AKI: Epidemiology, Risk Factors, and Prevention
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Barreto, Erin F., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Johnson, Evan Christopher, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Eder, Ty, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Garcia Nieves, Yessie Ann, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Kashani, Kianoush, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Kattah, Andrea G., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- May, Heather P., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- McCoy, Rozalina G., University of Maryland Medical System, Baltimore, Maryland, United States
- Murphy, Daniel P., University of Minnesota Medical School, Minneapolis, Minnesota, United States
- Rule, Andrew D., Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
- Wieruszewski, Patrick M, Mayo Foundation for Medical Education and Research, Rochester, Minnesota, United States
Background
Acute kidney injury (AKI) and acute kidney disease (AKD) are associated with poor outcomes. Sodium glucose co-transporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are nephroprotective in diabetes and chronic kidney disease, but their role in AKI survivors is uncertain. This study evaluated the evidence regarding the impact of exposure to SGLT2i or GLP-1 RAs after AKI or AKD on outcomes.
Methods
In this systematic review with meta-analysis (no. CRD42024607838), Embase, MEDLINE, Scopus, Web of Science Core Collection, and clinical trials registries were searched for observational studies and randomized clinical trials from database inception to September 12, 2024. Included studies evaluated adults (≥18 years) with AKI or AKD during a hospitalization and compared patients subsequently exposed to SGLT2i or GLP-1 RAs to those not exposed. Articles were screened, data were extracted, and quality assessments were performed. The primary outcome was major adverse kidney events (MAKE). Random effects meta-analysis was performed using the inverse variance method. Pooled odds ratios with 95% confidence intervals were calculated.
Results
Six observational studies and one randomized trial met eligibility criteria (N = 212,046 patients). Six studies related to SGLT2i and one related to GLP-1 RAs. SGLT2i/GLP-1 RA exposure was associated with lower odds of MAKE (OR 0.63, 95% CI 0.46-0.86). Secondarily, SGLT2i/GLP-1 RA were associated with a lower odds of all-cause mortality (OR 0.36, 95% CI 0.21-0.62). Kidney replacement therapy at discharge was only evaluated in studies of SGLT2is where the risk was lower with SGLT2i therapy (OR 0.61, 95% CI 0.40-0.93). In just SGLT2i data findings for MAKE and mortality were consistent with the overall analysis [MAKE OR 0.63, 95% CI 0.42-0.95; Mortality OR 0.34 (95% CI 0.18, 0.65)].
Conclusion
In predominantly observational studies, exposure to SGLT2i or GLP-1 RAs after an episode of AKI or AKD was associated with lower odds of MAKE, need for kidney replacement therapy, and death. These findings are promising and warrant confirmation in randomized clinical trials.