Abstract: SA-PO0516
Acute Change in Kidney Function After Concomitant Initiation of SGLT2 Inhibitors and RAAS Inhibitors: A Retrospective Case-Control Study
Session Information
- CKD: Clinical - Therapies, CKM Health, Special Populations, and More
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Szeto, Cheuk-Chun, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
- Ng, Jack Kit-Chung, The Chinese University of Hong Kong Faculty of Medicine, Hong Kong, Hong Kong
Background
Renin-angiotensin-aldosterone system inhibitors (RAASi) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) are effective treatment for chronic kidney disease (CKD). The initiation of RAASi and SGLT2i, however, can result in an acute rise in serum creatinine. There are concerns that simultaneous initiation of both may cause a drastic rise in serum creatinine, which may result in inadvertent withdrawal of effective treatment.
Methods
Between 2020 and 2024, we identified 839 CKD patients who had simultaneous initiation of SGLT2i and RAASi (DUAL group). By propensity score-matching, same number of patients with background RAASi and initiation of SGLT2i (SEQ group), and those newly started on RAASi alone (RAAS group), were identified. The primary outcome was percentage change in serum creatinine in 7 to 30 days. Secondary outcome include the proportion of patients with ≥30% increase in serum creatinine and hyperkalemia.
Results
Serum creatinine increased by 6.0 ± 17.2, 4.5 ± 17.2, and 1.8 ± 19.6% for DUQL, SEQ, and RAAS groups, respectively (p<0.0001). DUAL group had a significantly higher risk of a rise in serum creatinine by ≥30% than the SEQ (adjusted odds ratio [OR] 2.153, 95% confidence interval [CI] 1.409 to 3.344, p=0.0005) and the RAAS group (adjusted OR 1.574, 95%CI 1.059 to 2.361, p=0.026). The risk of hyperkalemia was significantly lower for the DUAL than RAAS group (0.8% vs 2.0%, p=0.040).
Conclusion
Our results indicate that SGLT2i and RAASi could be initiated simultaneously and the monitoring of kidney function after simultaneous initiation should be similar to that after initiation of RAASi alone.