PT - JOURNAL ARTICLE AU - Carina Iskander AU - David Z. Cherney AU - Kristin K. Clemens AU - Stephanie N. Dixon AU - Ziv Harel AU - Nivethika Jeyakumar AU - Eric McArthur AU - Flory Tsobo Muanda AU - Chirag R. Parikh AU - J. Michael Paterson AU - Navdeep Tangri AU - Jacob A. Udell AU - Ron Wald AU - Amit X. Garg TI - Use of sodium–glucose cotransporter-2 inhibitors and risk of acute kidney injury in older adults with diabetes: a population-based cohort study AID - 10.1503/cmaj.191283 DP - 2020 Apr 06 TA - Canadian Medical Association Journal PG - E351--E360 VI - 192 IP - 14 4099 - http://www.cmaj.ca/content/192/14/E351.short 4100 - http://www.cmaj.ca/content/192/14/E351.full SO - CMAJ2020 Apr 06; 192 AB - BACKGROUND: Regulatory agencies warn about the risk of acute kidney injury (AKI) after the initiation of sodium-glucose cotransporter-2 (SGLT2) inhibitors. Our objective was to quantify the 90-day risk of AKI in older adults after initiation of SGLT2 inhibitors in routine clinical practice.METHODS: We conducted a population-based retrospective cohort study in Ontario, Canada, involving adults with diabetes who were aged 66 years or older and who were newly dispensed either an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor in an outpatient setting between 2015 and 2017. We used inverse probability of treatment weighting based on a propensity score to balance the 2 groups on measured baseline characteristics. The primary outcome was 90-day risk of a hospital encounter (i.e., visit to the emergency department or admission to hospital) with AKI, which we defined by a 50% or greater increase in the concentration of serum creatinine from the baseline value or an absolute increase of at least 27 μmol/L after an SGLT2 or DDP4 inhibitor was dispensed. We obtained weighted risk ratios using modified Poisson regression and weighted risk differences using binomial regression.RESULTS: We included 39 094 patients with a median age of 70 (interquartile range 68–74) years in the study. Relative to new use of a DPP4 inhibitor, initiation of a SGLT2 inhibitor was associated with a lower 90-day risk of a hospital encounter with AKI: 216 events in 19 611 patients (1.10%) versus 388 events in 19 483 patients (1.99%); weighted risk ratio 0.79 (95% confidence interval 0.64–0.98).INTERPRETATION: In routine care of older adults, new use of SGLT2 inhibitors compared with use of DPP4 inhibitors was associated with a lower risk of AKI. Together with previous evidence, our findings suggest that regulatory warnings about AKI risk with SGLT2 inhibitors are unwarranted.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.200426