TOPLINE: 

Use of SGLT-2 inhibitor therapy at admission was associated with a 32% reduced risk for acute kidney injury (AKI) in hospitalised patients, and this benefit was maintained when therapy was continued during hospitalisation. Patients who received SGLT-2 inhibitor therapy at admission were also less likely to experience progression to severe stages of AKI.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using real-world data between 2021 and 2024 to evaluate the association between SGLT-2 inhibitor use at admission and during hospitalisation and the risk for AKI in hospitalised patients.
• They included 527 patients (mean age, 71.3 years; 68.1% men) who received prehospital SGLT-2 inhibitor therapy and 527 matched control patients who did not. SGLT-2 inhibitor therapy was indicated for heart failure in 16%, chronic kidney disease in 6%, type 2 diabetes in 7%, and at least two conditions in 72% of patients.
• Prehospital SGLT-2 inhibitor treatment was defined as an active prescription for this class of drugs on the day of hospital admission; patients were categorised as never-users (no prehospital or within-hospital SGLT-2 inhibitor use), starters (no prehospital use but within-hospital use), continuers (both prehospital and within-hospital use), or stoppers (prehospital use but no within-hospital use).
• The primary outcome was the incidence of AKI during hospitalisation.

TAKEAWAY:

• Patients receiving SGLT-2 inhibitors at admission had a 32% lower risk for AKI at hospitalisation than control patients (relative risk [RR], 0.68; 95% CI, 0.53-0.86).
• Patients who continued SGLT-2 inhibitor therapy during hospitalisation had a 35% lower risk for AKI than those who never used this therapy (RR, 0.65; 95% CI, 0.49-0.85).
• Among patients who developed AKI, those in the SGLT-2 inhibitor group were less likely to experience progression to severe stages than those in the control group, with AKI stage 2 occurring in 12% vs 27% of patients and AKI stage 3 occurring in 9% vs 10% of patients.
• Patients with AKI had longer hospital stays (median days, 7 vs 3) and higher in-hospital mortality rates (12.3% vs 2.5%) than individuals without AKI.

IN PRACTICE:

"Our real-world data suggests a substantial reduction in the risk of AKI during hospitalization in high-risk patients using SGLT-2i [SGLT-2 inhibitor], suggesting a significant renoprotective effect," the authors wrote.

SOURCE:

This study was led by Dion Gabriël Lodewijk de Martines, MD, University Medical Centre Utrecht, Utrecht, and Kenan Hasan Ali Aydinoglu, MD, Frisius Medical Centre, Leeuwarden, Netherlands. It was published online on April 27, 2026, in American Journal of Nephrology.

LIMITATIONS: 

The retrospective design may have introduced residual bias. Urine output was not routinely monitored and was not used as an AKI criterion, which may have resulted in missed AKI episodes. Additionally, the study was underpowered to assess rare outcomes such as mortality.

DISCLOSURES: 

This study did not receive any specific funding. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.