Risk of CKD among patients with DM taking diuretics or SGLT2i: a retrospective cohort study in Taiwan

• Published in: BMC pharmacology & toxicology Vol. 25; no. 1; p. 24
• Main Authors: Lin, Han-Jie, Shih, Pin-Yang, Tsai, Stella Chin-Shaw, Chuang, Wu-Lung, Hsieh, Tsai-Ling, Lin, Heng-Jun, Yu, Teng-Shun, Tsai, Fuu-Jen, Chen, Chiu-Ying, Chang, Kuang-Hsi
• Format: Journal Article
• Language: English
• Published: London BioMed Central 05.03.2024; BioMed Central Ltd
• Subjects: Age; Alcohol; Asthma; Big data and artificial intelligence for drug discovery; Biomedical and Life Sciences; Biomedicine; Chronic kidney failure; Chronic obstructive pulmonary disease; Codes; Cohort analysis; Comorbidity; Consent; Dapagliflozin; Diabetes; Diabetes mellitus; Diabetics; Diuretics; Diuretics - adverse effects; Edema; Health insurance industry; Heart failure; Humans; Inpatients; Medical research; Medicine, Experimental; National health insurance; Online databases; Patients; Pharmacology/Toxicology; Privacy; Renal function; Renal Insufficiency, Chronic - epidemiology; Retrospective Studies; Review boards; Risk; Taiwan - epidemiology; Taiwan; China; Diuretics; Sodium-glucose cotransporter-2 inhibitors (SGLT2i); Chronic kidney disease (CKD); National Health Insurance Research Database (NHIRD)
• ISSN: 2050-6511; 2050-6511
• DOI: 10.1186/s40360-024-00745-7

Background This study aimed to evaluate the long-term risk of CKD and renal function declines using a combination of diuretics and SGLT2i. Methods We selected the data of subjects who had at least two outpatient records or at least one inpatient record for DM treatment as the DM group from the National Health Insurance Research Database (NHIRD). Patients receiving versus not receiving SGLT2i were defined as the SGLT2i and non-SGLT2i cohorts, respectively. The patients in the two groups were matched 1:1 through propensity score matching based on age, sex, year of index date, and comorbidities. Results The diuretics-only group had a higher risk of CKD (aHR, 2.46; 95% CI, 1.68–3.61) compared to the neither SGLT2i nor diuretics group, while the both SGLT2i and diuretics group and the SGLT2i only group had lower risks (aHR, 0.45, 95% CI, 0.32–0.63; aHR, 0.26, 95% CI, 0.17–0.40) than the diuretics-only group. The SGLT2i-only group had a lower risk (aHR, 0.58, 95% CI, 0.36–0.94) than the both SGLT2i and diuretics group. Conclusion This study indicates that diuretics could raise the risk of CKD in diabetic patients, but when used in combination with SGLT2i, they continue to offer protection against CKD.