| アブストラクト | BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) reduce the risk of acute kidney injury (AKI) in diverse populations; however, their effects on drug-induced AKI remain unclear. Nonsteroidal anti-inflammatory drugs (NSAIDs) are a major cause of nephrotoxicity, and combining them with renin-angiotensin-aldosterone system inhibitors and diuretics increases the risk. Given the natriuretic action of SGLT2is, their impact on NSAID-related AKI requires evaluation. METHODS: We performed this retrospective cohort study using the nationwide Japanese claims database (2015-2023). Adults with type 2 diabetes initiated on NSAIDs while receiving either SGLT2is or dipeptidyl peptidase-4 inhibitors (DPP4is) were included. Inverse probability of treatment weighting balanced 60 covariates. The primary outcome was 90-day AKI, identified by International Classification of Diseases 10th edition codes, and the secondary outcomes were 30-day risk and on-treatment incidence during NSAID use. RESULTS: We identified 39,251 SGLT2i and 256,298 DPP4i users. After weighting, the covariates were well balanced. The occurrence rates of 90-day AKI were 0.17% and 0.24% in SGLT2i and DPP4i users, respectively (risk ratio 0.70, 95% confidence interval: 0.62-0.79). Consistent protection was observed at 30 days and during on-treatment exposure. Subgroup analyses showed greater benefit in younger patients and those with chronic kidney disease, higher BMIs, and shorter exposure. None of the subgroups demonstrated excess risk. CONCLUSIONS: SGLT2i therapy was associated with a significantly lower risk of NSAID-induced AKI than DPP4is. These findings indicate an observed association between SGLT2i therapy and a lower incidence of drug-induced nephrotoxicity, which may inform safer NSAID prescribing in patients with type 2 diabetes. CLINICAL TRIAL NUMBER: Not applicable. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12882-026-04753-z. |
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| ジャーナル名 | BMC nephrology |
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| Pubmed追加日 | 2026/1/17 |
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| 投稿者 | Kunitsu, Yuki; Koide, Hiroyoshi; Ikuta, Keiko; Hira, Daiki; Nakagawa, Shunsaku; Tsuda, Masahiro; Morita, Shin-Ya; Terada, Tomohiro |
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| 組織名 | Department of Clinical Pharmacology and Therapeutics, Kyoto University Hospital,;54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.;ykunitsu@kuhp.kyoto-u.ac.jp.;Department of Pharmacy, Shiga University of Medical Science Hospital, Seta;Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.;Graduate School of Pharmaceutical Sciences, Kyoto University, 46-29;Yoshida-Shimo-Adachi-cho, Sakyo-ku, Kyoto, 606-8501, Japan. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/41545961/ |
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