Kidney Week

Abstract: TH-PO159

SGLT2 Inhibitors and Fracture Risk in Individuals with Advanced CKD

Session Information

• CKD-MBD: Clinical
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Bone and Mineral Metabolism

• 502 Bone and Mineral Metabolism: Clinical

Authors

• Issa, Rochell, Cleveland Clinic, Cleveland, Ohio, United States

Rochell Issa, MD

• Fardi, Yasameen, University Hospitals, Cleveland, Ohio, United States

Yasameen Fardi, DO

• Brateanu, Andrei, Cleveland Clinic, Cleveland, Ohio, United States

Andrei Brateanu, MD

• Negrea, Lavinia Aura, University Hospitals, Cleveland, Ohio, United States

Lavinia Aura Negrea, MD, FASN

• Dobre, Mirela A., University Hospitals, Cleveland, Ohio, United States

Mirela A. Dobre, MD, FASN, MPH

Background

The risk of fracture in elderly individuals with advanced chronic kidney disease (CKD) treated with sodium-glucose cotransporter-2 inhibitors (SGLT2i) is debated.

Methods

In this retrospective cohort study of electronic health records (EHRs) of approximately 105.3 million patients from 61 healthcare organizations from the US Collaborative Network TriNetX, a prevalent new-user design was applied. Two cohorts of adults age 65 or older, with CKD stages 4, 5, and 5D were assembled between January 2014 and December 2019, with follow-up until April 2024. The cohort of patients initiated on SGLT2i was matched in a 1:1 ratio, to a cohort of patients not on SGLT2i, but otherwise prescribed the same background drugs, duration of background drugs, co-morbidities, and time conditional propensity score. Cox proportional hazards models were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of major central or peripheral fractures separately at 6 months, 1 and 5 years.

Results

We identified a total of 18,391 (with CKD stage 4 and 5) and 11,084 (with CKD-5D) new users of an SGLT2i. The 6 month, 1 and 5 year risks of a central or peripheral fragility fracture did not significantly differ between new users of SGLT2i versus non-users (Table). Individuals with CKD 5D demonstrated the same trend. Similar results but with wider confidence intervals were obtained in analyses restricted to Canagliflozin use across all CKD stages and fracture types.

Conclusion

In this large US cohort, the use of SGLT-2i was not associated with an increased risk of either central of peripheral fractures in individuals with advanced CKD stages 4, 5, or 5D.

Fracture risk by CKD stage and fracture type at 6 months, 1 and 5 years in SGLT2i users (+) vs non-users (-)

Funding

• Other NIH Support