JAMA Intern Med

SGLT2 inhibitors may protect against hyperkalemia in patients on RAAS inhibitors

May 1, 2025

Study details: This Canadian population-based retrospective cohort study included adults ≥66 years of age who were prescribed renin-angiotensin-aldosterone system inhibitors (RAASi) and had a history of diabetes, heart failure, or chronic kidney disease. Researchers compared 20,063 users of sodium-glucose cotransporter 2 inhibitors (SGLT2i) to 19,781 nonusers, using inverse probability of treatment weighting to balance baseline covariates.

Results: SGLT2i initiation was associated with a lower risk of hyperkalemia (hazard ratio: 0.89; 95% confidence interval [CI]: 0.82-0.96) and fewer hospitalizations for hyperkalemia. SGLT2i users also had a significantly lower rate of RAASi discontinuation compared with nonusers (36% vs. 45%; P<.001).

Clinical impact: The findings suggest that SGLT2 inhibitors can mitigate the risk of hyperkalemia in patients receiving RAASi, potentially improving adherence to RAASi therapy and enhancing overall clinical outcomes for patients with diabetes, heart failure, or chronic kidney disease.

Source:

Wing S, et al. (2025, April 28). JAMA Intern Med. SGLT2 Inhibitors and Risk for Hyperkalemia Among Individuals Receiving RAAS Inhibitors. https://pubmed.ncbi.nlm.nih.gov/40293730/