PMID- 30084579
OWN - NLM
STAT- MEDLINE
DCOM- 20190523
LR  - 20190523
IS  - 1565-1088 (Print)
VI  - 20
IP  - 8
DP  - 2018 Aug
TI  - Clinical Spectrum and Mechanism of Acute Kidney Injury in Patients with Diabetes 
      Mellitus on SGLT-2 Inhibitors.
PG  - 513-516
AB  - BACKGROUND: Sodium-glucose cotransporter 2 inhibitors (SGLT2i) (such as 
      canagliflozin, empagliflozin, and dapagliflozin) are widely used to treat 
      patients with type 2 diabetes mellitus (T2DM) to improve glycemic, cardiovascular 
      and renal outcomes. However, based on post-marketing data, a warning label was 
      added regarding possible occurrence of acute kidney injury (AKI). OBJECTIVES: To 
      describe the clinical presentation of T2DM patients treated with SGLT2i who were 
      evaluated for AKI at our institution and to discuss the potential 
      pathophysiologic mechanisms. METHODS: A retrospective study of a computerized 
      database was conducted of patients with T2DM who were hospitalized or evaluated 
      for AKI while receiving SGLT2i, including descriptions of clinical and laboratory 
      characteristics, at our institution. RESULTS: We identified seven patients in 
      whom AKI occurred 7-365 days after initiation of SGLT2i. In all cases, 
      renin-angiotensin-aldosterone system blockers had also been prescribed. In five 
      patients, another concomitant nephrotoxic agent (injection of contrast-product, 
      use of nonsteroidal anti-inflammatory drugs or cox-2 inhibitors) or occurrence of 
      an acute medical event potentially associated with AKI (diarrhea, sepsis) was 
      identified. In two patients, only the initiation of SGLT2i was evident. The 
      mechanisms by which AKI occurs under SGLT2i are discussed with regard to the 
      associated potential triggers: altered trans-glomerular filtration or, 
      alternatively, kidney medullary hypoxia. CONCLUSIONS: SGLT2i are usually safe and 
      provide multiple benefits for patients with T2DM. However, during particular 
      medical circumstances, and in association with usual co-medications, particularly 
      if baseline glomerular filtration rate is decreased, patients treated with SGLT2i 
      may be at risk of AKI, thus warranting caution when prescribed.
FAU - Perlman, Amichai
AU  - Perlman A
AD  - Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, 
      Jerusalem, Israel.
FAU - Heyman, Samuel N
AU  - Heyman SN
AD  - Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, 
      Jerusalem, Israel.
FAU - Stokar, Joshua
AU  - Stokar J
AD  - Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, 
      Jerusalem, Israel.
FAU - Darmon, David
AU  - Darmon D
AD  - Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, 
      Jerusalem, Israel.
FAU - Muszkat, Mordechai
AU  - Muszkat M
AD  - Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, 
      Jerusalem, Israel.
FAU - Szalat, Auryan
AU  - Szalat A
AD  - Department of Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus, 
      Jerusalem, Israel.
LA  - eng
PT  - Journal Article
PL  - Israel
TA  - Isr Med Assoc J
JT  - The Israel Medical Association journal : IMAJ
JID - 100930740
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Sodium-Glucose Transporter 2 Inhibitors)
SB  - IM
MH  - Acute Kidney Injury/*chemically induced
MH  - Aged
MH  - Diabetes Mellitus, Type 2/*drug therapy
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/*adverse effects
MH  - Kidney/drug effects/physiopathology
MH  - Kidney Function Tests
MH  - Male
MH  - Middle Aged
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Sodium-Glucose Transporter 2 Inhibitors/*adverse effects
EDAT- 2018/08/08 06:00
MHDA- 2019/05/24 06:00
CRDT- 2018/08/08 06:00
PHST- 2018/08/08 06:00 [entrez]
PHST- 2018/08/08 06:00 [pubmed]
PHST- 2019/05/24 06:00 [medline]
PST - ppublish
SO  - Isr Med Assoc J. 2018 Aug;20(8):513-516.