Effects of sodium-glucose transporter-2 inhibition on systemic hemodynamics, renal function, and intra-renal oxygenation in sepsis-associated acute kidney injury

Background People with type 2 diabetes mellitus treated with sodium-glucose transporter-2 inhibitors (SGLT2i) have
lower rates of acute kidney injury (AKI). Sepsis is responsible for the majority of AKI in critically ill patients. This study
investigated whether SGLT2i is renoprotective in an ovine model of Gram-negative septic AKI.
Methods Sixteen healthy merino ewes were surgically instrumented to enable measurement of mean arterial pres-
sure, cardiac output, renal blood flow, renal cortical and medullary perfusion, and oxygenation. After a 5-day recovery
period, sepsis was induced via slow and continuous intravenous infusion of live Escherichia coli. Twenty-three hours
later, sheep were randomized to receive an intravenous bolus of 0.2 mg/kg empagliflozin (n
=
8) or a fluid-matched
vehicle (n
=
8).
Results Empagliflozin treatment did not significantly reduce renal medullary hypoperfusion or hypoxia, improve
kidney function, or induce histological changes. Renal cortical oxygenation during the intervention period
was 47.6 ± 5.9 mmHg in the empagliflozin group compared with 40.6 ± 8.2 mmHg in the placebo group (P
=
0.16).
Renal medullary oxygenation was 28.0 ± 18.5 mmHg in the empagliflozin compared with 25.7 ± 16.3 mmHg (P
=
0.82).
Empagliflozin treatment did not result in significant between-group differences in renal blood flow, kidney function,
or renal histopathological changes.
Conclusion In a large mammalian model of septic AKI, a single dose of empagliflozin did not improve renal microcir-
culatory perfusion, oxygenation, kidney function, or histopathology.