SGLT2 抑制剂与老年 2 型糖尿病患者急性肾损伤风险。
SGLT2 Inhibitors and the Risk of Acute Kidney Injury in Older Adults With Type 2 Diabetes.
机构信息
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Renal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Division of Renal Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; New England Geriatric Research, Education and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts.
出版信息
Am J Kidney Dis. 2022 Jun;79(6):858-867.e1. doi: 10.1053/j.ajkd.2021.09.015. Epub 2021 Nov 8.
RATIONALE & OBJECTIVE: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been found to have many benefits for patients with type 2 diabetes. However, whether SGLT2 inhibitors increase the risk of acute kidney injury (AKI) remains unknown. We examined the association of AKI hospitalization with prior initiation of an SGLT2 inhibitor compared with initiation of a dipeptidyl peptidase 4 (DPP-4) inhibitor or a glucagon-like peptide 1 receptor agonist (GLP-1RA) among older adults with type 2 diabetes in routine practice.
STUDY DESIGN
Population-based cohort study.
SETTING & PARTICIPANTS: Older adults aged at least 66 years with type 2 diabetes enrolled in Medicare fee-for-service and who were new users of SGLT2 inhibitor, DPP-4 inhibitor, or GLP-1RA agents in the interval from March 2013 to December 2017.
EXPOSURES
New use of an SGLT2 inhibitor versus new use of a DPP-4 inhibitor or GLP-1RA.
OUTCOME
The primary outcome was hospitalization for AKI, defined as a discharge diagnosis of AKI in the primary or secondary position.
ANALYTICAL APPROACH
New users of SGLT2 inhibitors were matched at a 1:1 ratio to new users of DPP-4 inhibitors or GLP-1RAs using propensity scores in 2 pairwise comparisons. Cox proportional hazards regression models generated hazard ratios (HRs) with 95% CIs in propensity score-matched groups.
RESULTS
Totals of 68,130 and 71,477 new users of SGLT2 inhibitors were matched to new users of DPP-4 inhibitors or GLP-1RAs, respectively. Overall, the mean age of study participants was 72 years. The risk of AKI was lower in the SGLT2 inhibitor group than in the DPP-4 inhibitor group (HR, 0.71 [95% CI, 0.65-0.76]) or the GLP-1RA group (HR, 0.81 [95% CI, 0.75-0.87]).
LIMITATIONS
Residual confounding and lack of laboratory data.
CONCLUSIONS
Among older adults with type 2 diabetes, initiation of an SGLT2 inhibitor was associated with a reduced risk of AKI compared with initiation of a DPP-4 inhibitor or a GLP-1RA.
背景与目的
钠-葡萄糖协同转运蛋白 2（SGLT2）抑制剂已被证明对 2 型糖尿病患者有诸多益处。然而，SGLT2 抑制剂是否会增加急性肾损伤（AKI）的风险尚不清楚。我们在常规实践中，比较了老年 2 型糖尿病患者中 SGLT2 抑制剂起始治疗与二肽基肽酶 4（DPP-4）抑制剂或胰高血糖素样肽 1 受体激动剂（GLP-1RA）起始治疗与 AKI 住院之间的相关性。
研究设计
基于人群的队列研究。
研究场所与参与者
2013 年 3 月至 2017 年 12 月，在 Medicare 按服务收费制下登记、且新使用 SGLT2 抑制剂、DPP-4 抑制剂或 GLP-1RA 的年龄至少 66 岁的 2 型糖尿病患者。
暴露
新使用 SGLT2 抑制剂与新使用 DPP-4 抑制剂或 GLP-1RA。
结局
主要结局为 AKI 住院，定义为主要或次要诊断为 AKI 的出院诊断。
分析方法
在 2 项配对比较中，采用倾向评分将新使用 SGLT2 抑制剂者以 1:1 的比例与新使用 DPP-4 抑制剂或 GLP-1RA 者进行匹配。在倾向评分匹配组中，Cox 比例风险回归模型生成了风险比（HR）及其 95%置信区间。
结果
总计 68130 名和 71477 名新使用 SGLT2 抑制剂者分别与新使用 DPP-4 抑制剂或 GLP-1RA 者匹配。总体而言，研究参与者的平均年龄为 72 岁。与 DPP-4 抑制剂组（HR，0.71[95%CI，0.65-0.76]）或 GLP-1RA 组（HR，0.81[95%CI，0.75-0.87]）相比，SGLT2 抑制剂组的 AKI 风险较低。
局限性
残余混杂和缺乏实验室数据。
结论
在老年 2 型糖尿病患者中，与起始 DPP-4 抑制剂或 GLP-1RA 相比，起始 SGLT2 抑制剂与 AKI 风险降低相关。
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