{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T19:14:55Z","timestamp":1787166895740,"version":"build-2736575974"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,10,10]],"date-time":"2024-10-10T00:00:00Z","timestamp":1728518400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004359","name":"Swedish Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004359","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Swedish Heart and Lung Foundation"},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01 DK115534"],"award-info":[{"award-number":["R01 DK115534"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010909","name":"Young Scientists Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010909","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82304245"],"award-info":[{"award-number":["82304245"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003246","name":"Netherlands Organisation for Scientific Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,28]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Post hoc analyses of clinical trials suggest that sodium-glucose cotransporter-2 inhibitors (SGLT-2i) lower the risk of hyperkalemia and facilitate the use of renin\u2013angiotensin system inhibitors (RASi) in people with type 2 diabetes. Whether this is also observed in routine care is unclear. We investigated whether SGLT-2i lowered the risk of hyperkalemia and RASi discontinuation as compared to dipeptidyl peptidase 4 inhibitors (DPP-4i).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the target trial emulation framework, we studied adults with type 2 diabetes (T2D) who started SGLT-2i or DPP-4i in Stockholm, Sweden (2014\u20132021). The outcomes were incident hyperkalemia (potassium &amp;gt;5.0\u2009mmol\/l), mild hyperkalemia (potassium &amp;gt;5\u2013\u22645.5\u00a0mmol\/l), and moderate to severe hyperkalemia (potassium &amp;gt;5.5\u00a0mmol\/l). Among RASi users, we studied time to RASi discontinuation through evaluation of pharmacy fills. Cox regression with inverse probability of treatment weighting was used to estimate per-protocol hazard ratios (HRs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 29\u2009849 individuals (15\u2009326 SGLT-2i and 14\u2009523 DPP-4i initiators) were included (mean age 66 years, 37% women). About one-third of participants in each arm discontinued treatment within 1 year. Compared with DPP-4i, SGLT-2i use was associated with a lower rate of hyperkalemia (HR 0.77; 95% CI: 0.64\u20130.93), including both mild (0.76; 0.62\u20130.93) and moderate\/severe (0.53; 0.40\u20130.69) hyperkalemia events. Of 19\u2009116 participants who used RASi at baseline, 7% discontinued therapy. Initiation of SGLT-2i vs. DPP-4i was not associated with the rate of RASi discontinuation (0.97; 0.83\u20131.14). Results were consistent in intention-to-treat analysis and across strata of sex, cardiovascular disease, use of MRA, and use of RASi.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In patients with diabetes managed in routine clinical care, the use of SGLT-2i was associated with lower rates of hyperkalemia compared with DPP-4i. Possibly because of a relatively high rate of treatment discontinuations, this was not accompanied by higher persistence on RASi therapy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ndt\/gfae227","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T15:21:42Z","timestamp":1728400902000},"page":"956-966","source":"Crossref","is-referenced-by-count":5,"title":["Hyperkalemia and maintenance of renin\u2013angiotensin system inhibitor therapy after initiating SGLT-2 or DPP-4 inhibitors"],"prefix":"10.1093","volume":"40","author":[{"given":"Alessandro","family":"Bosi","sequence":"first","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1074-608X","authenticated-orcid":false,"given":"Yang","family":"Xu","sequence":"additional","affiliation":[{"name":"Karolinska 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,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8650-5795","authenticated-orcid":false,"given":"Marie","family":"Evans","sequence":"additional","affiliation":[{"name":"Karolinska University Hospital Department of Renal Medicine, , Stockholm ,","place":["Sweden"]},{"name":"Intervention and Technology, Karolinska Institutet Department of Clinical Science, , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0374-6927","authenticated-orcid":false,"given":"Jung-Im","family":"Shin","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health Department of Epidemiology, , Baltimore ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9698-6825","authenticated-orcid":false,"given":"Edouard L","family":"Fu","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]},{"name":"Leiden University Medical Center Department of Clinical Epidemiology, , Leiden ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4763-2024","authenticated-orcid":false,"given":"Juan Jesus","family":"Carrero","sequence":"additional","affiliation":[{"name":"Karolinska Institutet Department of Medical Epidemiology and Biostatistics, , Stockholm ,","place":["Sweden"]},{"name":"Karolinska Institutet, Danderyd Hospital Division of Nephrology, Department of Clinical Sciences, , Stockholm 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