Use of SGLT2 Inhibitors in Patients with Chronic Kidney Disease and Urinary Tract Infection: Is There a Need for Concern?

Objective: This study aimed to investigate urinary tract infections (UTIs) and associated risk factors in patients with type 2 diabetes mellitus and chronic kidney disease (CKD), with or without treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i). Methods: We retrospectively analyzed diabetic CKD patients with available urine culture results. Patients were divided into two groups: those receiving SGLT2i therapy and those not receiving it. The groups were compared retrospectively with respect to the development of urinary tract infection at 12-month follow-up, using clinical and laboratory results. Results: A total of 151 patients with T2DM were included, with a median age of 70 years (range: 61-76), and 84 (56%) were female. Among them, 91 (60%) patients were treated with SGLT2i. BMI, plasma glucose levels, and the urine protein/creatinine ratio were significantly lower in the SGLT2i group (p = 0.002, p = 0.049, and p < 0.001, respectively), while serum urea and creatinine levels were significantly higher (p = 0.048 and p = 0.028, respectively). A total of 59 patients (39.1%) had positive urine cultures, 32 of whom (35.2%) were using SGLT2i. There was no statistically significant difference in UTI incidence between SGLT2i users and non-users (p = 0.298). Among patients with positive cultures, Escherichia coli was the most common pathogen, identified in 52.5% (n = 31) of cases. Patients with positive urine cultures were older (p = 0.005), and 39 (66%) were female (p = 0.038). According to logistic regression analysis, advanced age and female sex were identified as independent risk factors for UTI (p = 0.037; Odds Ratio = 2.172, 95% CI: 1.048-4.502 and p = 0.033; Odds Ratio = 2.169, 95% CI: 1.065-4.415, respectively). Conclusions: In diabetic patients with CKD, the use of SGLT2i reduces proteinuria without increasing the risk of urinary tract infections. Advanced age and female sex are independent risk factors for UTI.