Annals of Internal MedicineSodium–Glucose Cotransporter-2 Inhibitors and the Risk for Dialysis and Cardiovascular Disease in Patients with Stage 5 Chronic Kidney Disease

SGLT2 Inhibitors Reduce Dialysis and Cardiovascular Risk in Advanced CKD with Type 2 Diabetes

A comprehensive study from Taiwan’s National Health Insurance Research Database has illuminated the significant benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in patients with stage 5 chronic kidney disease (CKD) and type 2 diabetes. This emulated target trial offers valuable insights into the reduction of dialysis and cardiovascular events through the application of SGLT2is, paving the way for enhanced treatment protocols in this high-risk population.

Study Design:

• Participants: Analysis included 23,854 SGLT2i users and 23,892 non-users with type 2 diabetes and stage 5 CKD.
• Setting: Data was sourced from Taiwan’s National Health Insurance Research Database, covering the period from May 1, 2016, to October 31, 2021.
• Methods: Employed conditional Cox proportional hazards models to compare outcomes between SGLT2i users and non-users.

Key Findings:

• Dialysis Risk: SGLT2i use was linked to a significantly lower risk of dialysis initiation (hazard ratio [HR], 0.34).
• Cardiovascular Events: Notable reduction in hospitalization for heart failure (HR, 0.80) and acute myocardial infarction (HR, 0.61).
• Other Complications: Decreased risk of diabetic ketoacidosis (HR, 0.78) and acute kidney injury (HR, 0.80).
• Mortality: No significant difference in all-cause mortality between groups (HR, 1.11).

HCN Medical Memo
This study reinforces the potential of SGLT2 inhibitors as a critical component in managing advanced CKD in diabetic patients. Although the benefits in reducing dialysis and cardiovascular events are compelling, the unchanged mortality rate suggests a complex interplay of factors that warrants further investigation and careful clinical judgement.

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