Sodium-Glucose Cotransporter-2 inhibitor use during or after acute kidney injury and the risk of major adverse kidney events and Mortality: A systematic review and Meta-Analysis
In brief
SGLT2 inhibitors linked to 35% lower mortality during or after acute kidney injury
Across seven studies, mostly observational, SGLT2 inhibitor use was associated with 35% lower all-cause mortality and lower odds of major adverse kidney events during or after acute kidney injury. The kidney-event finding varied across studies, and a randomized trial of 200 patients was inconclusive; very low-certainty evidence leaves open whether the apparent benefits are caused by treatment.
- Journal
- Diabetes research and clinical practice (Q1)
- Published
- 23 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Sama Abdel-Rahman, Joseph Marji, Abdullah Nasir, Mahmoud Jarrar, Anas Khodr Abdo, Maryam Mammadzada, et al.
- PMID
- 42918307
- DOI
- 10.1016/j.diabres.2026.113623
Why clinicians should know about it
- Picked for Internal Medicine (paper of the day, 25 October 2026): SGLT2 inhibitor evidence during or after acute kidney injury
- Picked for Nephrology (top studies of the week, 25 October 2026): SGLT2 inhibitor use and outcomes during or after AKI
Abstract
BACKGROUND: Acute kidney injury (AKI) is associated with substantial morbidity and mortality, and pharmacologic strategies to improve outcomes after AKI remain limited. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have established cardiovascular and renal benefits, but their role during or after AKI remains less clearly defined. METHODS: We conducted a systematic review and meta-analysis in accordance with PRISMA 2020 and registered the protocol in PROSPERO (CRD420261298733). Six databases were searched through February 9, 2026. Eligible studies enrolled adults with established AKI, compared SGLT2i use with control or nonuse, and reported at least one clinical outcome. Primary outcomes were all-cause mortality and major adverse kidney events (MAKE). Risk of bias was assessed with ROBINS-I and RoB 2 and certainty of evidence with GRADE. Random-effects meta-analysis pooled adjusted hazard ratios (HRs) for mortality and odds ratios (ORs) from crude event counts for MAKE. RESULTS: Seven studies were included (six observational, one randomized). SGLT2i use was associated with lower all-cause mortality (adjusted HR 0.65, 95% CI 0.59-0.71; I2 = 32%; three cohorts) and lower odds of MAKE (OR 0.63, 95% CI 0.44-0.88; I2 = 91%; five studies), but the MAKE estimate was not robust to exclusion of individual studies and MAKE definitions varied. Kidney replacement therapy (two studies) was not pooled. The randomized trial (n = 200) was inconclusive for mortality (OR 0.39, 95% CI 0.12-1.29) and MAKE (OR 0.93, 95% CI 0.52-1.67). Certainty of evidence was very low. CONCLUSIONS: SGLT2i use during or after AKI was associated with lower mortality and MAKE in observational studies (very low certainty of evidence), whereas the only randomized trial was too small to be conclusive. Confounding by indication is likely, and the evidence remains limited by heterogeneity and the predominance of observational data. Randomized trials are needed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.