{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T20:02:52Z","timestamp":1789243372289,"version":"build-2803163510"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The association between sodium-glucose transport protein 2 inhibitor (SGLT2i) use and the incidence of acute kidney injury (AKI) remains controversial. The benefits of SGLT2i use in patients to reduce AKI requiring dialysis (AKI-D) and concomitant diseases with AKI as well as improve AKI prognosis have not yet been established.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association between SGLT2i use and AKI incidence in patients with type 2 diabetes (T2D).<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This nationwide retrospective cohort study used the National Health Insurance Research Database in Taiwan. The study analyzed a propensity score\u2013matched population of 104\u202f462 patients with T2D treated with SGLT2is or dipeptidyl peptidase 4 inhibitors (DPP4is) between May 2016 and December 2018. All participants were followed up from the index date until the occurrence of outcomes of interest, death, or the end of the study, whichever was earliest. Analysis was conducted between October 15, 2021, and January 30, 2022.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was the incidence of AKI and AKI-D during the study period. AKI was diagnosed using International Classification of Diseases <\/jats:italic>diagnostic codes, and AKI-D was determined using the diagnostic codes and dialysis treatment during the same hospitalization. Conditional Cox proportional hazard models assessed the associations between SGLT2i use and the risks of AKI and AKI-D. The concomitant diseases with AKI and its 90-day prognosis, ie, the occurrence of advanced chronic kidney disease (CKD stage 4 and 5), end-stage kidney disease, or death, were considered when exploring the outcomes of SGLT2i use.<\/jats:p><\/jats:sec>Results<\/jats:title>In a total of 104\u202f462 patients, 46\u202f065 (44.1%) were female patients, and the mean (SD) age was 58 (12) years. After a follow-up of approximately 2.50 years, 856 participants (0.8%) had AKI and 102 (&amp;lt;0.1%) had AKI-D. SGLT2i users had a 0.66-fold risk for AKI (95% CI, 0.57-0.75; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and 0.56-fold risk of AKI-D (95% CI, 0.37-0.84; P<\/jats:italic>\u2009=\u2009.005) compared with DPP4i users. The numbers of patients with AKI with heart disease, sepsis, respiratory failure, and shock were 80 (22.73%), 83 (23.58%), 23 (6.53%), and 10 (2.84%), respectively. SGLT2i use was associated with lower risk of AKI with respiratory failure (hazard ratio [HR], 0.42; 95% CI, 0.26-0.69; P<\/jats:italic>\u2009&amp;lt;\u2009.001) and shock (HR, 0.48; 95% CI, 0.23-0.99; P<\/jats:italic>\u2009=\u2009.048) but not AKI with heart disease (HR, 0.79; 95% CI, 0.58-1.07; P<\/jats:italic>\u2009=\u2009.13) and sepsis (HR, 0.77; 95% CI, 0.58-1.03; P<\/jats:italic>\u2009=\u2009.08). The 90-day AKI prognosis for the risk of advanced CKD indicated a 6.53% (23 of 352 patients) lower incidence in SGLT2i users than in DPP4i users (P<\/jats:italic>\u2009=\u2009.045).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>The study findings suggest that patients with T2D who receive SGLT2i may have lower risk of AKI and AKI-D compared with those who receive DPP4i.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.0453","type":"journal-article","created":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T16:01:35Z","timestamp":1677081695000},"page":"e230453","source":"Crossref","is-referenced-by-count":36,"title":["Sodium-Glucose Transport Protein 2 Inhibitor Use for Type 2 Diabetes and the Incidence of Acute Kidney Injury in Taiwan"],"prefix":"10.1001","volume":"6","author":[{"given":"Mu-Chi","family":"Chung","sequence":"first","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"},{"name":"PhD Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peir-Haur","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Chiayi, Taiwan"},{"name":"Department of Applied Life Science and Health, Chia-Nan University of Pharmacy and Science, Tainan, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Po-Jen","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Urology, China Medical University and Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laing-You","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao-Hsiang","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Urology, China Medical University and Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Yu","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Division of Thoracic Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Ju","family":"Wu","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeng-Jer","family":"Shieh","sequence":"additional","affiliation":[{"name":"Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan"},{"name":"Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan"},{"name":"Department of Education and Research, Taichung Veterans General Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chuen","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Chinese Medicine, China Medical University, Taichung, Taiwan"},{"name":"Department of Medical Research, China Medical University Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi-Jung","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan"},{"name":"Department of Medical Research, China Medical University Hospital, Taichung, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,2,22]]},"reference":[{"issue":"4","key":"zoi230029r1","doi-asserted-by":"publisher","first-page":"1135","DOI":"10.1681\/ASN.2005060668","article-title":"Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001.","volume":"17","author":"Xue","year":"2006","journal-title":"J Am Soc Nephrol"},{"issue":"10","key":"zoi230029r2","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1038\/s41581-018-0052-0","article-title":"Global epidemiology and outcomes of acute kidney injury.","volume":"14","author":"Hoste","year":"2018","journal-title":"Nat Rev Nephrol"},{"issue":"3","key":"zoi230029r3","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1053\/j.ajkd.2019.10.010","article-title":"Critical care nephrology: core curriculum 2020.","volume":"75","author":"Griffin","year":"2020","journal-title":"Am J Kidney Dis"},{"key":"zoi230029r4","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/365186","article-title":"Long-term outcomes after dialysis-requiring acute kidney injury.","volume":"2014","author":"Wu","year":"2014","journal-title":"Biomed Res Int"},{"issue":"1","key":"zoi230029r5","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1681\/ASN.2020030323","article-title":"The relationship between AKI and CKD in patients with type 2 diabetes: an observational cohort study.","volume":"32","author":"Hapca","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"zoi230029r6","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/6232909","article-title":"Acute kidney injury in diabetes mellitus.","volume":"2016","author":"Patschan","year":"2016","journal-title":"Int J Nephrol"},{"issue":"4","key":"zoi230029r7","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1038\/s41581-019-0247-z","article-title":"Long-term outcomes of acute kidney injury and strategies for improved care.","volume":"16","author":"James","year":"2020","journal-title":"Nat Rev Nephrol"},{"issue":"11","key":"zoi230029r8","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1016\/S2213-8587(19)30256-6","article-title":"SGLT2 inhibitors for the prevention of kidney failure in patients with type 2 diabetes: a systematic review and meta-analysis.","volume":"7","author":"Neuen","year":"2019","journal-title":"Lancet Diabetes Endocrinol"},{"issue":"7","key":"zoi230029r9","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.1210\/clinem\/dgab274","article-title":"Clinical adverse events associated with sodium-glucose cotransporter 2 inhibitors: a meta-analysis involving 10 randomized clinical trials and 71 553 individuals.","volume":"106","author":"Lin","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"issue":"6","key":"zoi230029r10","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1053\/j.ajkd.2021.09.015","article-title":"SGLT2 inhibitors and the risk of acute kidney injury in older adults with type 2 diabetes.","volume":"79","author":"Zhuo","year":"2022","journal-title":"Am J Kidney Dis"},{"issue":"11","key":"zoi230029r11","doi-asserted-by":"publisher","first-page":"1479","DOI":"10.2337\/dc17-1011","article-title":"Acute kidney injury in patients on SGLT2 inhibitors: a propensity-matched analysis.","volume":"40","author":"Nadkarni","year":"2017","journal-title":"Diabetes Care"},{"issue":"20","key":"zoi230029r12","doi-asserted-by":"publisher","first-page":"2191","DOI":"10.1001\/jama.2013.281053","article-title":"World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects.","volume":"310","author":"World Medical Association","year":"2013","journal-title":"JAMA"},{"issue":"3","key":"zoi230029r13","first-page":"157","article-title":"Accuracy of diabetes diagnosis in health insurance claims data in Taiwan.","volume":"104","author":"Lin","year":"2005","journal-title":"J Formos Med Assoc"},{"issue":"3","key":"zoi230029r14","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1681\/ASN.2013060610","article-title":"Long-term risk of coronary events after AKI.","volume":"25","author":"Wu","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"zoi230029r15","doi-asserted-by":"publisher","first-page":"9","DOI":"10.2147\/CLEP","article-title":"Validity of the coding for intensive care admission, mechanical ventilation, and acute dialysis in the Danish National Patient Registry: a short report.","volume":"5","author":"Blichert-Hansen","year":"2013","journal-title":"Clin Epidemiol"},{"issue":"7","key":"zoi230029r16","doi-asserted-by":"publisher","first-page":"813","DOI":"10.1001\/jama.294.7.813","article-title":"Acute renal failure in critically ill patients: a multinational, multicenter study.","volume":"294","author":"Uchino","year":"2005","journal-title":"JAMA"},{"issue":"2","key":"zoi230029r17","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1002\/pst.v10.2","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm Stat"},{"issue":"10","key":"zoi230029r18","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1002\/sim.6058","article-title":"Metrics for covariate balance in cohort studies of causal effects.","volume":"33","author":"Franklin","year":"2014","journal-title":"Stat Med"},{"issue":"1","key":"zoi230029r19","doi-asserted-by":"publisher","first-page":"16","DOI":"10.21037\/atm","article-title":"Balance diagnostics after propensity score matching.","volume":"7","author":"Zhang","year":"2019","journal-title":"Ann Transl Med"},{"issue":"1","key":"zoi230029r20","doi-asserted-by":"publisher","first-page":"70","DOI":"10.2215\/CJN.11220720","article-title":"Network meta-analysis of novel glucose-lowering drugs on risk of acute kidney injury.","volume":"16","author":"Zhao","year":"2020","journal-title":"Clin J Am Soc Nephrol"},{"issue":"4","key":"zoi230029r21","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.000933","article-title":"The impact of acute kidney injury on the long-term risk of stroke.","volume":"3","author":"Wu","year":"2014","journal-title":"J Am Heart Assoc"},{"issue":"4","key":"zoi230029r22","doi-asserted-by":"publisher","first-page":"700","DOI":"10.2215\/CJN.06080616","article-title":"SGLT2 inhibition in the diabetic kidney: from mechanisms to clinical outcome.","volume":"12","author":"van Bommel","year":"2017","journal-title":"Clin J Am Soc Nephrol"},{"key":"zoi230029r23","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2021.100895","article-title":"Acute effects of dapagliflozin on renal oxygenation and perfusion in type 1 diabetes with albuminuria: a randomised, double-blind, placebo-controlled crossover trial.","volume":"37","author":"Laursen","year":"2021","journal-title":"EClinicalMedicine"},{"issue":"4","key":"zoi230029r24","doi-asserted-by":"publisher","first-page":"3625","DOI":"10.3892\/mmr","article-title":"Renoprotection of dapagliflozin in human renal proximal tubular cells via the inhibition of the high mobility group box 1-receptor for advanced glycation end products-nuclear factor-?B signaling pathway.","volume":"18","author":"Yao","year":"2018","journal-title":"Mol Med Rep"},{"issue":"1","key":"zoi230029r25","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s10787-020-00732-4","article-title":"Empagliflozin suppresses inflammation and protects against acute septic renal injury.","volume":"29","author":"Maayah","year":"2021","journal-title":"Inflammopharmacology"},{"key":"zoi230029r26","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopha.2021.111624","article-title":"SGLT2 inhibitor empagliflozin monotherapy alleviates renal oxidative stress in albino Wistar diabetic rats after myocardial infarction induction.","volume":"139","author":"Ahmed","year":"2021","journal-title":"Biomed Pharmacother"},{"issue":"6","key":"zoi230029r27","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1097\/FJC.0000000000001268","article-title":"Dapagliflozin attenuates contrast-induced acute kidney injury by regulating the HIF-1a\/HE4\/NF-?B pathway.","volume":"79","author":"Huang","year":"2022","journal-title":"J Cardiovasc Pharmacol"},{"key":"zoi230029r28","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1016\/j.gene.2019.05.009","article-title":"Potential protective effects of dapagliflozin in gentamicin induced nephrotoxicity rat model via modulation of apoptosis associated miRNAs.","volume":"707","author":"Mohamed","year":"2019","journal-title":"Gene"},{"issue":"10254","key":"zoi230029r29","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/S0140-6736(20)31824-9","article-title":"SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials.","volume":"396","author":"Zannad","year":"2020","journal-title":"Lancet"},{"issue":"4","key":"zoi230029r30","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1002\/ehf2.v9.4","article-title":"Empagliflozin reduces markers of acute kidney injury in patients with acute decompensated heart failure.","volume":"9","author":"Thiele","year":"2022","journal-title":"ESC Heart Fail"},{"issue":"1","key":"zoi230029r31","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1186\/s12933-022-01455-2","article-title":"Efficacy and safety of sodium-glucose cotransporter 2 inhibitors initiation in patients with acute heart failure, with and without type 2 diabetes: a systematic review and meta-analysis.","volume":"21","author":"Salah","year":"2022","journal-title":"Cardiovasc Diabetol"},{"issue":"5","key":"zoi230029r32","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1038\/ki.2011.379","article-title":"Chronic kidney disease after acute kidney injury: a systematic review and meta-analysis.","volume":"81","author":"Coca","year":"2012","journal-title":"Kidney Int"},{"issue":"4","key":"zoi230029r33","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1038\/nrneph.2017.2","article-title":"Acute kidney disease and renal recovery: consensus report of the Acute Disease Quality Initiative (ADQI) 16 Workgroup.","volume":"13","author":"Chawla","year":"2017","journal-title":"Nat Rev Nephrol"},{"issue":"3","key":"zoi230029r34","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/j.kint.2018.05.002","article-title":"A sodium-glucose cotransporter 2 inhibitor attenuates renal capillary injury and fibrosis by a vascular endothelial growth factor-dependent pathway after renal injury in mice.","volume":"94","author":"Zhang","year":"2018","journal-title":"Kidney Int"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2801729\/chung_2023_oi_230029_1676399783.98272.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,22]],"date-time":"2023-02-22T16:01:38Z","timestamp":1677081698000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2801729"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,22]]},"references-count":34,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,2,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.0453","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,22]]}}}