Earlier SGLT2 Inhibitor Use After AKI Linked to Fewer Kidney Events

Receiving a first documented prescription for a sodium-glucose cotransporter-2 (SGLT2) inhibitor within 30 days after hospital discharge was associated with fewer adverse kidney events than receiving a first prescription 31 to 90 days after discharge among adults with type 2 diabetes recovering from dialysis-requiring acute kidney injury, according to a target-trial emulation published in JAMA Network Open.

Investigators used electronic health record data from the TriNetX Global Collaborative Network. Eligible patients had required dialysis during their index hospitalization and subsequently discontinued dialysis. Propensity-score matching produced 1,912 patients in each treatment-timing group.

The composite kidney outcome included dialysis reinitiation, incident end-stage kidney disease or chronic kidney disease stage 5, or a recorded estimated glomerular filtration rate below 15 mL/min/1.73 m². Adverse kidney events occurred in 74 early initiators (3.9%) and 119 later initiators (6.2%), corresponding to an adjusted hazard ratio of 0.62 (P=.001).

The association was driven primarily by fewer patients with an estimated glomerular filtration rate below 15 mL/min/1.73 m². Dialysis reinitiation did not differ significantly. Investigators also found no significant differences in all-cause mortality, major adverse cardiovascular events, myocardial infarction, stroke, or recorded 6-month safety outcomes. These safety outcomes included urinary tract infection, diabetic ketoacidosis, heart failure, hypoglycemia, diabetic retinopathy, volume depletion, and genitourinary fungal infection.

The observational study remains susceptible to residual confounding, exposure misclassification, incomplete electronic health record capture, and timing bias. The findings therefore support further evaluation of post-AKI treatment timing rather than establishing that earlier SGLT2 inhibitor prescribing causes better kidney outcomes.

Source: Chou YT, Chen JY, Jiang ZH, Lin LC, Wu VC. Early sodium-glucose cotransporter-2 inhibitor use after acute kidney injury in type 2 diabetes. JAMA Netw Open. 2026;9(8):e2631231. doi:10.1001/jamanetworkopen.2026.31231