Potential Hypoxic Renal Injury in Patients With Diabetes on SGLT2 Inhibitors: Caution Regarding Concomitant Use of NSAIDs and Iodinated Contrast Media

In their seminal work, Wanner et al. (1) found that the sodium–glucose cotransporter 2 (SGLT2) inhibitor empagliflozin provided renal protection over 4 years of follow-up in patients with type 2 diabetes. Furthermore, the incidence of overt acute kidney injury (AKI) showed a trend in favor of the treatment group, especially beyond 18 months of randomization. However, a recent U.S. Food and Drug Administration Drug Safety Communication reports 101 cases of AKI in patients treated with SGLT2 inhibitors, some of whom required hospitalization and dialysis (2). There might be a few explanations for this troubling news, other than mere chance and publication bias. While an initial reduction in glomerular filtration rate, related to transglomerular pressure reduction, is a reversible inherent factor of long-term renal protection, SGLT2 inhibition could potentially …