SGLT2 억제제, 급성 신손상

Acute kidney injury — 

There have been postmarketing reports of acute kidney injury, some requiring hospitalization and dialysis, in patients taking canagliflozinor dapagliflozin. Among 101 cases of possible SGLT2-associated acute kidney injury reported to the FDA, approximately one-half occurred within one month of initiating the drug, and most patients improved after the drug was discontinued. Some patients with acute kidney injury may have been volume depleted, hypotensive, or taking other medications that could affect the kidneys. It is unclear whether any of the patients in these reports had preexisting chronic kidney disease.

In a subsequent analysis of SGLT2 users and nonusers in two different cohorts, the risk of acute kidney injury was not increased with SGLT2 inhibitor use. Furthermore, in trials that were designed to evaluate cardiovascular morbidity and mortality in patients with type 2 diabetes and established cardiovascular disease (CVD), empagliflozin and canagliflozin reduced the incidence of worsening nephropathy, suggesting a renal protective effect.

Nevertheless, renal function should be assessed prior to initiation of SGLT2 inhibitors and monitored during treatment. They should be used with caution in patients with comorbidities that might predispose to acute renal injury (eg, heart failure, hypovolemia) and in conjunction with other medications that predispose to acute renal injury (nonsteroidal anti-inflammatory drugs [NSAIDs], ACE inhibitors/ARBs, diuretics). Dose adjustments and more frequent monitoring are required when estimated glomerular filtration rate (eGFR) is 45 to 60 mL/min. 


REF. UpToDate 2018.05.01