Acute eGFR Dip with SGLT2 Inhibitors vs. Other Antihyperglycemic Medications Among People with HIV
Author(s)
Lara Haidar, MSc, PharmD1, Robin Nance, PhD2, Laila Aboulatta, PharmD1, Bridget Whitney, PhD2, Sarah L. Mixson, MPH2, Stephanie Ruderman, PhD2, Heidi Crane, MD2, Joseph A Delaney, PhD2, Sherif Eltonsy, PhD1.
1University of Manitoba, Winnipeg, MB, Canada, 2University of Washington, Seattle, WA, USA.
1University of Manitoba, Winnipeg, MB, Canada, 2University of Washington, Seattle, WA, USA.
OBJECTIVES: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) offer cardiorenal benefits in the general population but may cause an acute eGFR dip, raising safety concerns, especially for people with HIV (PWH) who are at higher risk for renal complications. This study aimed to evaluate the risk of acute eGFR decline with SGLT2i compared to other antihyperglycemic classes in PWH.
METHODS: We conducted an observational study using data from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (1996-2023). PWH initiating SGLT2i or other antihyperglycemic agents (GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas) were included if they had ≥2 eGFR measurements: one at baseline and one within 6 months of medication initiation, with the date of initiation defined as the index date. Outcomes included (1) time to ≥10% decline in eGFR analyzed using Cox proportional hazards models, and (2) absolute change in eGFR at 6 months analyzed using linear mixed models. Analyses were adjusted for demographic and clinical covariates.
RESULTS: Among 2095 patients included, 299 were new users of SGLT2i and 1796 of other antihyperglycemic classes. Mean age at baseline was 52 years (SD: 10), with 75% male, 47% Black, 85% with diabetes, and a mean eGFR of 81 (SD: 25). In adjusted analysis, new users of SGLT2is had a 67% increased risk of a ≥10% decline in eGFR compared to other antihyperglycemic medications (aHR 1.67, 95% CI: 1.38-2.02). At 6 months, SGLT2i had a larger eGFR decline of −4.72 mL/min/1.73 m² (95% CI: −7.98, −1.45) compared to other antihyperglycemic classes −1.75 mL/min/1.73 m² (95% CI: −3.34, −0.16).
CONCLUSIONS: Among PWH, SGLT2i were associated with a higher risk of acute eGFR decline compared to other antihyperglycemic classes, though the decline was modest and similar to that observed in the general population. Further studies are needed to confirm long-term nephroprotective benefits in PWH.
METHODS: We conducted an observational study using data from the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (1996-2023). PWH initiating SGLT2i or other antihyperglycemic agents (GLP-1 receptor agonists, DPP-4 inhibitors, or sulfonylureas) were included if they had ≥2 eGFR measurements: one at baseline and one within 6 months of medication initiation, with the date of initiation defined as the index date. Outcomes included (1) time to ≥10% decline in eGFR analyzed using Cox proportional hazards models, and (2) absolute change in eGFR at 6 months analyzed using linear mixed models. Analyses were adjusted for demographic and clinical covariates.
RESULTS: Among 2095 patients included, 299 were new users of SGLT2i and 1796 of other antihyperglycemic classes. Mean age at baseline was 52 years (SD: 10), with 75% male, 47% Black, 85% with diabetes, and a mean eGFR of 81 (SD: 25). In adjusted analysis, new users of SGLT2is had a 67% increased risk of a ≥10% decline in eGFR compared to other antihyperglycemic medications (aHR 1.67, 95% CI: 1.38-2.02). At 6 months, SGLT2i had a larger eGFR decline of −4.72 mL/min/1.73 m² (95% CI: −7.98, −1.45) compared to other antihyperglycemic classes −1.75 mL/min/1.73 m² (95% CI: −3.34, −0.16).
CONCLUSIONS: Among PWH, SGLT2i were associated with a higher risk of acute eGFR decline compared to other antihyperglycemic classes, though the decline was modest and similar to that observed in the general population. Further studies are needed to confirm long-term nephroprotective benefits in PWH.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
EPH100
Topic
Epidemiology & Public Health
Topic Subcategory
Safety & Pharmacoepidemiology
Disease
SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Infectious Disease (non-vaccine), SDC: Urinary/Kidney Disorders