Starting SGLT2 inhibitors sooner after severe kidney injury may reduce complications, study suggests

Research from National Taiwan University Hospital indicates that initiating SGLT2 inhibitors within 30 days of hospital discharge after severe kidney injury may lead to better kidney outcomes in adults with type 2 diabetes, prompting calls for further clinical trials on optimal timing.

A study led by National Taiwan University Hospital suggests that adults with type 2 diabetes who restarted an SGLT2 inhibitor soon after a severe kidney injury did better than those who waited longer. Published in JAMA Network Open, the research looked at patients recovering from acute kidney injury severe enough to require dialysis and found that beginning the drug within 30 days of hospital discharge was linked with fewer serious kidney complications than starting it between 31 and 90 days later.

The analysis used de-identified electronic health records from the TriNetX Global Collaborative Network and identified 4,406 adults who had needed dialysis during a hospital stay, stopped dialysis after discharge and then received an SGLT2 inhibitor within 90 days. After statistical matching to make the groups more comparable, the main comparison included 1,912 early starters and 1,912 later starters. According to the study, adverse kidney events occurred in 3.9% of the early group and 6.2% of the later group, with the difference driven mainly by fewer patients reaching very low kidney function rather than by a clear reduction in the need to restart dialysis.

The findings fit with a broader body of evidence showing that SGLT2 inhibitors protect the kidneys in people with diabetes and chronic kidney disease. Reviews and meta-analyses published in journals including JAMA, PLOS Medicine and Clinical Kidney Journal have found that the drugs reduce kidney failure and slow disease progression, while not increasing the risk of acute kidney injury. Researchers involved in the new study said the results should not be taken as proof of cause and effect, because the work was observational, but argued that timing may be a practical factor during recovery from severe kidney injury and that further clinical trials are needed to determine when these medicines should be started.