Early SGLT-2 Inhibitor Use May Benefit Kidney Recovery After AKI-D: JAMA

A new study published in the Journal of the American Medical Association revealed that among adults with type 2 diabetes recovering from dialysis-requiring acute kidney injury (AKI-D), starting an sodium-glucose cotransporter-2 (SGLT-2) inhibitor within 30 days of hospital discharge was associated with fewer adverse kidney events when compared to initiation 31–90 days after discharge. No significant differences were observed in mortality, cardiovascular events, or short-term recorded safety outcomes. These findings support timely SGLT-2 inhibitor initiation during post-AKI recovery, while prospective randomized trials are needed to confirm the benefit and safety.

The study evaluated electronic health records from the TriNetX Global Collaborative Network using a target trial emulation design. The collected data focused on adults with type 2 diabetes who had been hospitalized with AKI requiring dialysis, later recovered kidney function sufficiently to discontinue dialysis after discharge, and had not received an SGLT-2 inhibitor during the previous year.

A total of 4,406 eligible patients were identified before propensity score matching. Among them, 2,268 patients received their first SGLT-2 inhibitor prescription within 30 days of discharge, while 2,138 initiated treatment between 31 and 90 days. After 1:1 propensity score matching, 1,912 patients remained in each group, creating balanced cohorts for comparison. Patients were followed for an average of 3.4 years.

The primary outcome was the occurrence of adverse kidney events, defined as dialysis reinitiation, progression to end-stage kidney disease, or a recorded estimated glomerular filtration rate below 15 mL/min/1.73 m². Early initiation of SGLT-2 inhibitors was associated with a notable reduction in these events. Only 3.9% of patients who began therapy within 30 days experienced an adverse kidney outcome, compared with 6.2% of those who started treatment later. This translated to a 38% lower adjusted risk of adverse kidney events for the early-treatment group.

Despite the kidney benefit, this study found no statistically significant differences in all-cause mortality or major adverse cardiovascular events between early and later initiation. 6-month safety assessments also revealed comparable rates of recorded adverse events, suggesting that prescribing SGLT-2 inhibitors earlier during recovery did not introduce additional short-term safety concerns.

SGLT-2 inhibitors are already established therapies for improving kidney and cardiovascular outcomes in patients with type 2 diabetes, chronic kidney disease, and heart failure. However, uncertainty has persisted regarding the most appropriate time to begin treatment after recovery from severe acute kidney injury requiring dialysis. Overall, the findings from this real-world analysis suggest that delaying therapy may forgo an opportunity to better preserve kidney health during the critical post-AKI recovery period.

Reference:

Chou, Y.-T., Chen, J.-Y., Jiang, Z.-H., Lin, L.-C., & Wu, V.-C. (2026). Early sodium-glucose cotransporter-2 inhibitor use after acute kidney injury in type 2 diabetes. JAMA Network Open, 9(8), e2631231. https://doi.org/10.1001/jamanetworkopen.2026.31231