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논문분류	춘계학술대회 초록집
제목	The Protective Effects of SGLT-2 Inhibitors Against Postoperative Acute Kidney Injury in Type 2 Diabetes
저자	Seung Min Song
출판정보	2025; 2025(1):
키워드	AKI, SGLT-2i, DPP-4i, postoperative AKI, Diabetes
초록	Despite concerns about the potential of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) to cause AKI, recent studies have shown that diabetic patients on long-term SGLT-2i have lower rates of AKI-related hospitalizations and dialysis. We aimed to assess the real-world preventive effects of SGLT-2i on the risk of postoperative AKI. We conducted a retrospective study on diabetic patients who underwent a major surgery at a tertiary hospital in Korea from 2013 to 2023 (n = 5,527). We compared patients receiving SGLT-2i with those receiving dipeptidyl peptidase-4 inhibitors (DPP-4i) before surgery to evaluate the development of AKI within seven days after surgery. A 1:3 propensity score matching was performed to adjust for 10 potential confounders. Before matching, the mean age was 67.5 years, with males comprising 66.3% of the cohort. In the matched cohort, the incidence of postoperative AKI was 11.9% in patients on SGLT-2i and 15.1% in those on DPP-4i (P = 0.026). In a multivariable logistic regression analysis adjusted for various risk factors, the use of SGLT-2i was associated with a 31% reduction in the risk of postoperative AKI (odds ratio [OR] 0.699; 95% confidence interval [CI] 0.528-0.918; P = 0.011). Subgroup analyses demonstrated a significant protective effect of SGLT-2i in high-risk populations, particularly in patients with heart failure undergoing cardiovascular surgery, where the incidence of AKI increased to 54%, in which SGLT-2i reduced the risk of AKI by up to 57% (OR 0.431; 95% CI 0.205-0.889; P = 0.024). However, the SGLT-2i group experienced a higher incidence of mild diabetic ketoacidosis (DKA) than the DPP-4i group (0.8% vs 0%; P < 0.001). The use of SGLT-2i was independently associated with a lower risk of postoperative AKI compared to DPP-4i in patients with type 2 diabetes, particularly in high-risk groups such as those with heart failure undergoing cardiovascular surgery.
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