Acute kidney injury risk with SGLT2 inhibitors versus sulfonylureas by baseline cardiorenal status in type 2 diabetes: A nationwide cohort study
Abstract
Abstract Background : Evidence on the short-term renal safety of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in Asian populations is limited. In this study, we evaluated whether SGLT2i initiation as metformin-based second-line therapy is associated with a lower 180-day risk of acute kidney injury (AKI) compared with sulfonylureas (SUs), and whether this association varies by baseline cardiorenal status. Methods: We used Korean National Health Insurance Service claims data from 2013 to 2022 to conduct a nationwide retrospective cohort study. Eligible adults with type 2 diabetes mellitus who newly initiated either an SGLT2i or an SU as add-on therapy to metformin were included. After exact matching on the diagnosis-to-treatment interval, we performed 1:1 propensity score matching. The primary outcome was incident AKI within 180 days, identified using validated claims algorithms; biopsy-confirmed acute interstitial nephritis was a secondary outcome. Stratified Cox proportional hazards models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs). Additional analyses examined variation by heart failure (HF), chronic kidney disease (CKD), cumulative exposure, and individual agents, with sensitivity analyses to test robustness. Results: After matching, 125,832 SGLT2i initiators were compared with 125,832 SU initiators. SGLT2i initiation was associated with a lower 180-day AKI risk than SU initiation (aHR: 0.63, 95% CI: 0.55–0.72). This association was…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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