Predictors of asymptomatic ketonemia in outpatients with diabetic kidney disease receiving SGLT-2 inhibitors: a cross-sectional study
Abstract
Sodium–glucose cotransporter-2 (SGLT-2) inhibitors are now foundational therapy for diabetic chronic kidney disease (CKD), yet their ketogenic metabolic effects in this population remain incompletely characterised. While euglycaemic diabetic ketoacidosis is a recognised complication, the prevalence and clinical determinants of subclinical asymptomatic ketonemia in patients with diabetic CKD receiving SGLT-2 inhibitors have not been systematically evaluated. We aimed to determine the prevalence of asymptomatic ketonemia, defined by point-of-care capillary β-hydroxybutyrate (β-HB) positivity, and to identify its independent clinical predictors in this population. This cross-sectional study enrolled 211 consecutive adult outpatients with diabetic CKD receiving SGLT-2 inhibitor therapy (empagliflozin or dapagliflozin). Capillary β-HB was measured under standardised fasting conditions using a point-of-care ketone meter; positivity was defined as β-HB ≥ 0.6 mmol/L. Univariate comparisons were performed using the Mann–Whitney U test, independent-samples t-test, χ² test, or Fisher’s exact test as appropriate. Given the low number of outcome events (n = 16), Firth’s penalised logistic regression was employed as the primary multivariable analysis to mitigate small-sample bias. Asymptomatic ketonemia was detected in 16 of 211 patients (7.6%), all of whom were clinically asymptomatic at measurement. In Firth’s penalised logistic regression, heart failure (OR 4.46; 95% CI 1.48–13.51; p =…
How strong is the evidence?
Evidence Hub reads this as a cross-sectional, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause. Reported size: 16 participants or records.
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