Kidney Week

Abstract: SA-PO049

Impact of SGLT2 Inhibitors on the Risk of Postoperative AKI

Session Information

• AKI: Clinical, Outcomes, and Trials - Management
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Song, Seungmin, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Seungmin Song, MD

• Kim, Minhyung, Samsung Medical Center, Gangnam-gu, Seoul, Korea (the Republic of)

Minhyung Kim, MD

• Lee, Kyungho, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Kyungho Lee, MD, PhD

• Jeon, Junseok, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Junseok Jeon, MD, PhD

• Jang, Hye Ryoun, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Hye Ryoun Jang, MD, PhD

• Huh, Wooseong, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Wooseong Huh, MD, PhD

• Lee, Jung eun, Samsung Medical Center, Gangnam-gu, Korea (the Republic of)

Jung eun Lee, MD, PhD

Background

Sodium-glucose cotransporter-2 inhibitors (SGLT-2i), recognized for the cardiovascular and renal benefits, impact intraglomerular pressure through tubuloglomerular feedback restoration, potentially altering the risk of acute kidney injury (AKI). This is supported by increased AKI occurrences in patients receiving Renin-Angiotensin-Aldosterone system inhibitors. We aimed to assess the real-world preventive effects of SGLT-2i on risk of postoperative AKI.

Methods

We conducted a retrospective study on diabetic patients who underwent a major surgery at a tertiary hospital in Korea from 2013 to 2023 (n=5902). We compared patients taking SGLT-2i with those taking dipeptidyl peptidase-4 inhibitors (DPP4i) before surgery to evaluate the development of AKI within seven days after surgery. Due to substantial differences in baseline characteristics between the two groups, we performed 1:3 propensity score matching to adjust for 11 potential confounders.

Results

Before matching, the mean age was 67.4 years, with males comprising 66.5% of the cohort. In the unmatched cohort, the incidence of AKI was 14.4% in the SGLT2i group (n=1006) and 14.9% in the DPP-4i group (n=4896), showing no difference between the two groups. Following matching, the incidence of postoperative AKI was 12.9% in patients with SGLT-2i and 16.0% in those with DPP-4i (p=0.030). This difference persisted even after adjusting for patient and operation-related factors (odds ratio 0.742; 95% confidence interval 0.565-0.968; p=0.029). Moreover, the development of severe AKI, defined as a serum creatinine increase of three times or more, was 0.1% in the SGLT-2i group and 1.0% in the DPP-4i group (p=0.014).

Conclusion

The use of SGLT-2i were independently associated with a lower risk of postoperative AKI than the use of DPP-4i in type 2 diabetes. SGLT-2i could potentially become the first-line medication for preventive use in high-risk groups for postoperative AKI.