SGLT2 Inhibitors Reduce Hyperkalemia in High-Risk T2DM Patients
Hyperkalemia can occur in people with type 2 diabetes, especially in those with chronic kidney disease (CKD), and is clinically important because it can lead to life-threatening arrhythmias.
A recent study suggests that sodium-glucose cotransporter 2 (SGLT2) inhibitors reduced the risk of serious hyperkalemia (serum potassium ≥6.0 mmol/L) with no increased risk of hypokalemia in patients with CKD and/or cardiovascular risk. The study findings were published in the journal Circulation on April 08, 2022.
SGLT2 inhibitors reduce the risk of cardiorenal events in people with type 2 diabetes at high cardiovascular risk or with CKD. However, their effect on hyperkalemia has not been systematically evaluated. Therefore, Dr Brendon L. Neuen and his team conducted a study to evaluate the effect of SGLT2 inhibitors in people with type 2 diabetes at high cardiovascular risk and/or with CKD.
In this meta-analysis, the researchers used individual participant data from randomized, double-blind, placebo-controlled clinical outcome trials with SGLT2 inhibitors in people with type 2 diabetes at high cardiovascular risk and/or with CKD, in which serum potassium levels were routinely measured. The major outcome assessed was time to serious hyperkalemia, determined as central laboratory determine serum potassium ≥6.0 mmol/L, with other outcomes including investigator-reported hyperkalemia events and hypokalemia (serum potassium ≤3.5 mmol/L). They performed cox regression analyses were performed to estimate treatment effects from each trial with hazards ratios (HR) and corresponding 95% CI pooled using random-effects models to obtain summary treatment effects, overall and across key subgroups.
Key findings of the study:
- The researchers evaluated data from six trials comprising 49,875 participants assessing four SGLT2 inhibitors.
- Upon analysis, the researchers observed that 1,754 participants developed serious hyperkalemia and an additional 1,119 investigator-reported hyperkalemia events.
- They found that the SGLT2 inhibitors reduced the risk of serious hyperkalemia (HR 0.84, 95% CI 0.76-0.93), an effect consistent across studies.
- They noted that the incidence of investigator-reported hyperkalemia was also lower with SGLT2 inhibitors (HR 0.80).
- They reported that the reductions in serious hyperkalemia were observed across a range of subgroups including baseline kidney function, history of heart failure, RAAS inhibitor, diuretic and MRA use.
- They further noted that the SGLT2 inhibitors did not increase the risk of hypokalemia (HR 1.04, 95% CI 0.94-1.15).
The authors concluded, "SGLT2 inhibitors reduce the risk of serious hyperkalemia in people with type 2 diabetes at high cardiovascular risk and/or with CKD, without increasing the risk of hypokalemia."
For further information:
DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.057736
Keywords:
SGLT2 inhibitors, chronic kidney disease, hypokalemia, hyperkalemia, arrythmia, cardiovascular risk, cardiorenal events, sodium-glucose cotransporter 2 inihibitor, CV risk, CKD, journal Circulation.
