Impact of sodium-glucose cotransporter-2 inhibitors on clinical outcomes in patients with type 1 diabetes after dialysis-requiring acute kidney injury: a real-world cohort study.

AIMS: Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) have shown significant cardiovascular and kidney benefits, but their role in T1D with acute kidney disease (AKD) remains uncertain.

METHODS

This propensity-score matching cohort study utilized data from the TriNetX Network, including patients aged ≥18 years with T1D after dialysis requiring acute kidney disease (AKI) and were discharged from hospitals between 2012 and 2024. The primary outcomes were all-cause mortality, major adverse kidney events (MAKEs), and major adverse cardiovascular events (MACEs), analyzed using Cox proportional hazards regression models.

RESULTS

Among 16,680 patients with T1D and AKD, 614 (3.74%) patients received SGLT-2is, and matched with non-users. After a median follow-up of 1.7 years, SGLT-2i use was associated with lower all-cause mortality (aHR, 0.49; 95% CI, 0.36-0.71) and MAKEs (aHR, 0.53; 95% CI, 0.34-0.82), but no significant difference in MACEs (aHR, 0.86; 95% CI, 0.59-1.25). Genital infections and volume depletion were more frequent, without significant increase in diabetic ketoacidosis, urinary tract infections, or hypoglycemia.

CONCLUSIONS

In this study, SGLT-2i use was associated with improved kidney outcomes and reduced all-cause mortality in T1D patients with AKD. These findings suggest potential kidney and survival benefits, warranting further prospective validation.