Kidney Week

Abstract: TH-PO1058

SGLT2 Inhibitors, Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists, and the Risk of Hypokalemia and Hyperkalemia in a National Cohort of Veterans with Type 2 Diabetes

Session Information

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

Category: CKD (Non-Dialysis)

• 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

• Chakravartula, Akhil Ramanujam, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Akhil Ramanujam Chakravartula, MD, MBBS

• Hartsell, Sydney Elizabeth, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Sydney Elizabeth Hartsell, MD, MPH

• Sarwal, Amara, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Amara Sarwal, MD

• Wei, Guo, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Guo Wei, MS

• Nevers, Mckenna R., The University of Utah School of Medicine, Salt Lake City, Utah, United States

Mckenna R. Nevers, MSc

• Boucher, Robert E., The University of Utah School of Medicine, Salt Lake City, Utah, United States

Robert E. Boucher

• Katkam, Niharika, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Niharika Katkam, MSc

• Takyi, Augustine, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Augustine Takyi

• Shen, Jincheng, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Jincheng Shen, MS, PhD

• Greene, Tom, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Tom Greene, PhD

• Beddhu, Srinivasan, The University of Utah School of Medicine, Salt Lake City, Utah, United States

Srinivasan Beddhu, MD

Background

As SGLT2i are osmotic diuretics, they might increase the risk of hypokalemia and decrease the risk of hyperkalemia compared to other glycemic agents such as GLP1-RA or insulin glargine (IG).

Methods

Using the VA Informatics and Computing Infrastructure (VINCI) platform, in an active comparator new user design study, we compared the effects of IG, GLP1-RA, or SGLT2i on the risk of hypo and hyperkalemia. We identified veterans with T2D on metformin who initiated one of these 3 agents of interest for the first time between 1/1/18 to 12/31/21. We excluded those with prior prescriptions for these agents between 1/1/08 to 1/1/18. Index date was defined as the first date one of these agents were prescribed. Baseline demographics, BP, BMI, comorbidity, medications, lab data including eGFR and A1C were extracted. Follow-up was until 3/31/2023. Hyperkalemia and hypokalemia were identified using diagnostic codes. We used generalized propensity score based inverse probability weighting (IPW) to balance baseline variables across the study drug classes. IPW cox regression models related study drug class to outcomes.

Results

The study included 161,405 participants who were 64.9±10.8 years old, 94.6% male, 18.6% black at baseline with mean eGFR of 80± 20ml/min/1.73m² and 16.5% with baseline eGFR <60 ml/min/1.73m². There were 9,745 hyperkalemic events over 430,841 years of follow up, and 8,455 hypokalemic events over 433,548 years of follow up. The figure shows weighted cox model results of event rates and hazard ratio by pairwise drug comparison.

Conclusion

In veterans with T2D, IG is associated with a higher risk of both hyper- and hypokalemia compared to GLP1-RA or SGLT2i. Both SGLT2i and GLP1-RAs had similar risk of hypo or hyperkalemia.

Funding

• NIDDK Support