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Background <p>Sodium-glucose cotransporter-2 (SGLT2) inhibitors offer cardiovascular and renal benefits, but real-world predictors of adverse outcomes remain poorly defined, especially in Southeast Asian populations.</p> Objective <p>To evaluate clinical predictors of acute kidney injury (AKI), heart failure (HF) hospitalization, and major adverse cardiovascular events (MACE) in a real-world cohort of Malaysian patients prescribed SGLT2 inhibitors.</p> Methods <p>This retrospective cohort study included adults initiated on empagliflozin or dapagliflozin between January 2019 and December 2023 at a Malaysian hospital. Clinical characteristics, laboratory parameters, and medication use were assessed. Outcomes at 12&#xa0;months were analyzed using univariate and multivariate logistic regression to identify independent predictors.</p> Results <p>Among 116 patients (mean age 56.1 ± 13.4&#xa0;years; 76.7% male), AKI occurred in 23.3%, HF hospitalization in 12.9%, and MACE in 10.3%. Stroke was an independent predictor of AKI (aOR 19.45, 95% CI: 2.59–145.89; <i>p</i> = 0.004). Baseline eGFR and spironolactone use showed borderline associations. Higher baseline systolic blood pressure (aOR 1.05, 95% CI: 1.00–1.10; <i>p</i> = 0.049), serum sodium (aOR 1.35, 95% CI: 1.09–1.66; <i>p</i> = 0.006), and serum potassium (aOR 7.79, 95% CI: 1.33–45.72; <i>p</i> = 0.023) were independently associated with HF hospitalization. No variables remained independently associated with MACE after adjustment, although trends were noted for beta-blocker and spironolactone use.</p> Conclusions <p>SGLT2 inhibitors demonstrated an acceptable safety profile in this small, single-centre real-world cohort. However, given the observed event rates, continued vigilance is warranted, particularly among higher-risk subgroups such as patients with prior stroke or impaired renal function. These findings provide one of the first detailed evaluations of SGLT2 inhibitor outcomes in a Southeast Asian population and complement evidence from multinational trials. Importantly, they highlight the need for region-specific real-world data to support risk stratification and inform clinical decision-making in underrepresented populations.</p>

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Clinical determinants of renal and cardiovascular events in patients prescribed SGLT2 inhibitors: evidence from a Malaysian real-world cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月5日

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  • Abdullah Faiz Zaihan,
  • Nurul Ameera Huda Mohamad Hafiz,
  • Nur Irdina Athilah Khairul Hazamy,
  • Aisyah Zahraa Termizy,
  • Nurul Izzah Roslan,
  • Perishithaa M. Ganesan,
  • Sze Hwe Choe,
  • Chia Siang Kow

摘要

Background

Sodium-glucose cotransporter-2 (SGLT2) inhibitors offer cardiovascular and renal benefits, but real-world predictors of adverse outcomes remain poorly defined, especially in Southeast Asian populations.

Objective

To evaluate clinical predictors of acute kidney injury (AKI), heart failure (HF) hospitalization, and major adverse cardiovascular events (MACE) in a real-world cohort of Malaysian patients prescribed SGLT2 inhibitors.

Methods

This retrospective cohort study included adults initiated on empagliflozin or dapagliflozin between January 2019 and December 2023 at a Malaysian hospital. Clinical characteristics, laboratory parameters, and medication use were assessed. Outcomes at 12 months were analyzed using univariate and multivariate logistic regression to identify independent predictors.

Results

Among 116 patients (mean age 56.1 ± 13.4 years; 76.7% male), AKI occurred in 23.3%, HF hospitalization in 12.9%, and MACE in 10.3%. Stroke was an independent predictor of AKI (aOR 19.45, 95% CI: 2.59–145.89; p = 0.004). Baseline eGFR and spironolactone use showed borderline associations. Higher baseline systolic blood pressure (aOR 1.05, 95% CI: 1.00–1.10; p = 0.049), serum sodium (aOR 1.35, 95% CI: 1.09–1.66; p = 0.006), and serum potassium (aOR 7.79, 95% CI: 1.33–45.72; p = 0.023) were independently associated with HF hospitalization. No variables remained independently associated with MACE after adjustment, although trends were noted for beta-blocker and spironolactone use.

Conclusions

SGLT2 inhibitors demonstrated an acceptable safety profile in this small, single-centre real-world cohort. However, given the observed event rates, continued vigilance is warranted, particularly among higher-risk subgroups such as patients with prior stroke or impaired renal function. These findings provide one of the first detailed evaluations of SGLT2 inhibitor outcomes in a Southeast Asian population and complement evidence from multinational trials. Importantly, they highlight the need for region-specific real-world data to support risk stratification and inform clinical decision-making in underrepresented populations.