二肽基肽酶 4 抑制剂并未改善晚期糖尿病肾病的肾脏终点。

Dipeptidyl-Peptidase 4 Inhibitors did not Improve Renal Endpoints in Advanced Diabetic Kidney Disease.

机构信息

From (1)Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism,; School of Medicine of Chung Shan Medical University; Institute of Medicine of Chung Shan Medical University.

From (1)Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism,; Institute of Medicine of Chung Shan Medical University.

出版信息

Endocr Pract. 2020 Dec;26(12):1486-1496. doi: 10.4158/EP-2020-0143.

DOI:10.4158/EP-2020-0143

PMID:33471741

Abstract

OBJECTIVE

The efficacy of dipeptidyl-peptidase 4 inhibitors (DPP4is) in advanced diabetic kidney disease (DKD) is unknown. We investigated whether DPP4is confer renal protective benefits in DKD patients.

METHODS

We conducted a retrospective cohort study between 2012 and 2018 in Taiwan. We only included type 2 diabetes patients with estimated glomerular filtration rate (eGFR) between 30 and 90 mL/min/1.73 m and urine albumin to creatinine ratio between 300 and 5,000 mg/g. Patients with DPP4i prescriptions were selected as cases, while non-DPP4i users served as controls. We followed these patients until the presence of composite primary renal endpoints, which was defined by the earliest occur-rence of clinical renal outcomes.

RESULTS

A total of 522 patients were included in the analysis, comprising 273 patients with a DPP4i prescription who were selected as cases and 249 patients without DPP4i prescription who were assigned as controls. Median follow-up duration for DPP4i users and nonusers was 2.2 years and 3.4 years, respectively. At baseline, the mean glycated hemoglobin levels for DPP4i users and nonusers were 8.1% and 8.3%, respectively. Among patients with DPP4i prescriptions, there was no reduction in composite primary renal outcome, with a crude hazard ratio (HR) of 1.50 (95% confidence interval [CI], 0.95 to 2.36). Similar results were observed for the risk of persistent eGFR <15 mL/min/1.73 m, with a HR of 1.68 (95% CI, 0.90 to 3.13), doubling of serum creatinine level, with a HR of 1.05 (95% CI, 0.15 to 7.45), and end-stage renal disease, with a HR of 0.87 (95% CI, 0.14 to 5.19).

CONCLUSION

DPP4i prescription did not reduce the risk of composite renal endpoints in DKD patients.

ABBREVIATIONS

BMI = body mass index; CI = confidence interval; CVOT = cardiovascular outcomes trial; DPP4i = dipeptidyl-peptidase 4 inhibitor; DKD = diabetic kidney disease; eGFR = estimated glomerular filtration rate; ESRD = end-stage renal disease; HbA1c = glycated hemoglobin; HR = hazard ratio; SGLT2i = sodium-glucose cotransporter 2 inhibitor; T2D = type 2 diabetes; UACR = urine albumin to creatinine ratio.

摘要

目的

二肽基肽酶 4 抑制剂（DPP4i）在晚期糖尿病肾病（DKD）中的疗效尚不清楚。我们研究了 DPP4i 是否能为 DKD 患者带来肾脏保护益处。

方法

我们在 2012 年至 2018 年间进行了一项回顾性队列研究，纳入了估算肾小球滤过率（eGFR）在 30 至 90ml/min/1.73m2 之间且尿白蛋白与肌酐比值在 300 至 5000mg/g 之间的 2 型糖尿病患者。选择有 DPP4i 处方的患者作为病例，无 DPP4i 处方的患者作为对照。我们对这些患者进行随访，直至出现复合主要肾脏终点，即最早出现临床肾脏结局。

结果

共纳入 522 例患者，其中 273 例有 DPP4i 处方的患者作为病例，249 例无 DPP4i 处方的患者作为对照。DPP4i 使用者和非使用者的中位随访时间分别为 2.2 年和 3.4 年。在基线时，DPP4i 使用者和非使用者的糖化血红蛋白水平分别为 8.1%和 8.3%。在有 DPP4i 处方的患者中，复合主要肾脏结局没有减少，粗危险比（HR）为 1.50（95%置信区间[CI]，0.95 至 2.36）。持续性 eGFR<15ml/min/1.73m2 的风险也没有降低，HR 为 1.68（95%CI，0.90 至 3.13），血清肌酐水平翻倍的 HR 为 1.05（95%CI，0.15 至 7.45），终末期肾病的 HR 为 0.87（95%CI，0.14 至 5.19）。