Sodium-Glucose Cotransporter-2 Inhibitor Use and the Risk of Acute Kidney Injury in Older Adults in Routine Clinical Practice: A Population-Based Cohort Study
Abstract
Regulatory agencies warn about acute kidney injury (AKI) risk following sodium-glucose cotransporter-2 (SGLT2) inhibitor use. This population-based retrospective cohort study in Ontario, Canada quantified the 90-day AKI risk in older adults who were newly dispensed either SGLT2 inhibitors or dipeptidyl peptidase-4 (DPP4) inhibitors in an outpatient setting between 2015 and 2017. Risk ratios (RR) were obtained using modified Poisson regression and risk differences using binomial regression. Relative to new use of a DPP4 inhibitor, initiation of an SGLT2 inhibitor was associated with a lower 90-day risk of a hospital encounter with AKI: 216 events in 19,611 patients (1.10%) versus 388 events in 19,483 patients (1.99%); weighted RR 0.79 (95% confidence interval 0.64–0.98). In routine care of older adults, new SGLT2 inhibitor use was associated with lower risk of AKI. Together with previous evidence, these findings suggest that regulatory warnings about AKI risk with SGLT2 inhibitors may be unwarranted.