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Abstract: PO0967

Large Database Longitudinal Assessment of Electrolyte Abnormalities in Diabetic Patients Receiving SGLT2 Inhibitors

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Seethapathy, Harish Shanthanu, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Zhao, Sophia, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Allegretti, Andrew S., Massachusetts General Hospital, Boston, Massachusetts, United States
  • Kalim, Sahir, Massachusetts General Hospital, Boston, Massachusetts, United States
  • Nigwekar, Sagar U., Massachusetts General Hospital, Boston, Massachusetts, United States
Background

In diabetic patients, the osmotic diuresis and natriuresis induced by sodium glucose co-transporter 2 (SGLT2) inhibitors produces changes in the serum level of electrolytes such as potassium, magnesium and calcium. Incidence of electrolyte abnormalities induced by these agents in a ‘real-world’ setting has not been studied.

Methods

We included all patients with diabetes who were prescribed canagliflozin, empagliflozin or dapagliflozin at our healthcare system between 2012-2019. Demographics, baseline medication use, comorbidities, and laboratory values were obtained by querying a centralized research repository. Serum electrolyte levels at SGLT2 inhibitor initiation were compared to electrolyte levels in the 6 months after initiation and the most extreme post-baseline levels were used to determine incidence of electrolyte abnormalities.

Results

In total, 1630 patients were included. Average age was 61 (SD 11) years, 63% identified as male, 71% as white. Hypertension was present in 85%, congestive heart failure in 20%; 18% had an estimated glomerular filtration rate (eGFR) <60 mL/min/m2 and 12% had uncontrolled diabetes (A1C>10g/dL). ACE inhibitor/ARB use was present in 80% and 5% of patients (n=81) had elevated potassium (>5mEq/L) at baseline. In the first 6 months after drug initiation in patients without elevated potassium at baseline (n=1549), 12% experienced new hyperkalemia (>5 mEq/L) with 4% of patients experiencing a potassium level >5.5 mEq/L. Potassium >6 mEq/L was seen in 1%. Ten percent of patients with eGFR≥60 mL/min/m2 experienced hyperkalemia when compared to 21% of patients with eGFR<60 mL/min/m2 (p<0.01). Hyponatremia (<135 mEq/L) was seen in 12% of patients, with values <130 mEq/L seen in 2%. Hypomagnesemia (<1.5 mg/dL) was present in 3% and hypocalcemia (albumin-corrected calcium<7 mg/dL) was seen in 0.1%.

Conclusion

Patients with eGFR≤60 mL/min/m2 are particularly at high risk of developing hyperkalemia post-SGLT2 initiation. Effective monitoring and treatment strategies are needed to mitigate risks associated with hyperkalemia.

Incidence of electrolyte abnormalities (%)
Hyperkalemia (>5 mEq/L)12%
Hyponatremia (<135 mEq/L)12%
Hypomagnesemia (<1.5 mg/dL)3%
Hypocalcemia (<7 mg/dL)0.1%

Funding

  • Commercial Support – Relypsa Fellowship grant