Kidney Research Institute, Department of Nephrology, Chang Gung Memorial Hospital in Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan City, Taiwan.
JAMA Netw Open. 2022 Mar 1;5(3):e221169. doi: 10.1001/jamanetworkopen.2022.1169.
Glucagon-like peptide-1 (GLP-1) receptor agonist use is associated with reduced mortality and improved cardiovascular outcomes in the general population with diabetes. Dipeptidyl peptidase-4 (DPP-4) inhibitors are commonly used antidiabetic agents for patients with advanced-stage chronic kidney disease (CKD). The association of these 2 drug classes with outcomes among patients with diabetes and advanced-stage CKD or end-stage kidney disease (ESKD) is not well understood.
To assess whether use of GLP-1 receptor agonists in a population with diabetes and advanced-stage CKD or ESKD is associated with better outcomes compared with use of DPP-4 inhibitors.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used data on patients with type 2 diabetes and stage 5 CKD or ESKD obtained from the National Health Insurance Research Database of Taiwan. The study was conducted between January 1, 2012, and December 31, 2018. Data were analyzed from June 2020 to July 2021.
Treatment with GLP-1 receptor agonists compared with treatment with DPP-4 inhibitors.
All-cause mortality, sepsis- and infection-related mortality, and mortality related to major adverse cardiovascular and cerebrovascular events were compared between patients treated with GLP-1 receptor agonists and patients treated with DPP-4 inhibitors. Propensity score weighting was used to mitigate the imbalance among covariates between the groups.
Of 27 279 patients included in the study, 26 578 were in the DPP-4 inhibitor group (14 443 [54.34%] male; mean [SD] age, 65 [13] years) and 701 in the GLP-1 receptor agonist group (346 [49.36%] male; mean [SD] age, 59 [13] years). After weighting, the use of GLP-1 receptor agonists was associated with lower all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.63-0.98) and lower sepsis- and infection-related mortality (HR, 0.61; 95% CI, 0.40-0.91). Subgroup analysis demonstrated a lower risk of mortality associated with use of GLP-1 receptor agonists compared with DDP-4 inhibitors among patients with cerebrovascular disease (HR, 0.33; 95% CI, 0.12-0.86) than among those without cerebrovascular disease (HR, 0.89; 95% CI, 0.71-1.12) (P = .04 for interaction).
Treatment with GLP-1 receptor agonists was associated with lower all-cause mortality among patients with type 2 diabetes, advanced-stage CKD, and ESKD than was treatment with DPP-4 inhibitors. Additional well-designed, prospective studies are needed to confirm the potential benefit of GLP-1 receptor agonist treatment for patients with advanced CKD or ESKD.
胰高血糖素样肽-1（GLP-1）受体激动剂在一般糖尿病患者中的使用与死亡率降低和心血管结局改善相关。二肽基肽酶-4（DPP-4）抑制剂是常用于晚期慢性肾脏病（CKD）患者的抗糖尿病药物。这两类药物在患有糖尿病和晚期 CKD 或终末期肾病（ESKD）的患者中的疗效关联尚未得到充分了解。
评估在患有糖尿病和晚期 CKD 或 ESKD 的人群中使用 GLP-1 受体激动剂是否比使用 DPP-4 抑制剂有更好的结果。
设计、地点和参与者：本回顾性队列研究使用了从台湾全民健康保险研究数据库中获得的 2 型糖尿病和第 5 阶段 CKD 或 ESKD 患者的数据。研究于 2012 年 1 月 1 日至 2018 年 12 月 31 日进行。数据于 2020 年 6 月至 2021 年 7 月进行分析。
与 DPP-4 抑制剂相比，使用 GLP-1 受体激动剂。
比较使用 GLP-1 受体激动剂和 DPP-4 抑制剂的患者之间的全因死亡率、脓毒症和感染相关死亡率以及主要不良心血管和脑血管事件相关死亡率。使用倾向评分加权来减轻两组之间混杂因素的不平衡。
在纳入的 27279 名患者中，26578 名患者在 DPP-4 抑制剂组（14443 名[54.34%]男性；平均[标准差]年龄，65[13]岁），701 名患者在 GLP-1 受体激动剂组（346 名[49.36%]男性；平均[标准差]年龄，59[13]岁）。加权后，使用 GLP-1 受体激动剂与全因死亡率降低相关（风险比[HR]，0.79；95%置信区间[CI]，0.63-0.98）和降低的脓毒症和感染相关死亡率（HR，0.61；95% CI，0.40-0.91）。亚组分析表明，与 DPP-4 抑制剂相比，GLP-1 受体激动剂的使用与脑血管疾病患者（HR，0.33；95% CI，0.12-0.86）的死亡率降低相关，而与无脑血管疾病患者（HR，0.89；95% CI，0.71-1.12）（P=0.04 用于交互作用）。
与 DPP-4 抑制剂相比，2 型糖尿病、晚期 CKD 和 ESKD 患者使用 GLP-1 受体激动剂与全因死亡率降低相关。需要进行更多设计良好的前瞻性研究来证实 GLP-1 受体激动剂治疗对晚期 CKD 或 ESKD 患者的潜在益处。
