Vol.73 No.3 May 2025
Effect of diabetic comorbidities on urinary tract infection associated with sodium-glucose cotransporter 2 inhibitors in patients with chronic heart failure
1)Pharmacy Department, Yamaguchi University Hospital, 1-1-1 Minamikogushi, Ube, Yamaguchi, Japan
Abstract
Sodium-glucose cotransporter (SGLT) 2 inhibitors promote urinary glucose excretion and may thereby increase the risk of urinary tract infection in patients with diabetes mellitus (hereinafter, simply diabetes). Recently, treatment indications for SGLT2 inhibitors have expanded to other diseases, for example, chronic heart failure (CHF), so that this class of drugs has also begun to be used in patients without diabetes. However, the effect of comorbid diabetes on the risk of urinary tract infection posed by SGLT2 inhibitor therapy in patients with CHF remains unclear. In this study, we retrospectively investigated the association between underlying diabetes and the risk of urinary tract infection associated with SGLT2 inhibitor therapy in patients with CHF. Patients who had been diagnosed as having CHF and were receiving drug therapy between December 2020 and October 2022, who underwent urine culture testing were included in the analysis. Eligible patients were divided into two groups based on the presence/absence of comorbid diabetes. The frequency of urinary tract infection was compared between the two groups according to whether they were receiving SGLT2 inhibitor therapy. Among CHF patients without comorbid diabetes, the frequency of SGLT2 inhibitor administration was 11.2% in the non-urinary tract infection group (n=242) and 10.0% in the urinary tract infection group (n=20), with no significant difference between the two groups. However, among CHF patients with comorbid diabetes, the percentage of patients receiving SGLT2 inhibitor therapy was 15.6% in the non-urinary tract infection group (n=308) and 29.3% in the urinary tract infection group (n=41), with a significantly higher percentage of patients receiving SGLT2 inhibitor therapy in the urinary tract infection group (p=0.045). Multivariate logistic regression analysis using sex and age as covariates did not identify SGLT2 inhibitor therapy as a risk factor for urinary tract infection in CHF patients without comorbid diabetes (odds ratio [OR]; 0.86, 95% confidence interval [CI]; 0.18-4.09). However, in the CHF patients with comorbid diabetes, SGLT2 inhibitor therapy was identified as a risk factor for urinary tract infection (OR; 2.62, 95% CI; 1.22-5.62). Our study suggests that the risk of urinary tract infection associated with SGLT2 inhibitor therapy in patients with CHF varies depending on the presence/absence of comorbid diabetes.
Key word
sodium-glucose cotransporter 2 inhibitor, urinary tract infection, diabetes mellitus
Received
July 31, 2024
Accepted
January 7, 2025
Jpn. J. Chemother. 73 (3): 279-285, 2025
