Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
J Clin Endocrinol Metab. 2022 Jun 16;107(7):e2962-e2970. doi: 10.1210/clinem/dgac164.
Diabetic kidney disease is a major burden among diabetic patients. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) were shown to reduce renal outcomes in clinical trials and real-world studies. However, head-to-head comparisons with individual classes of glucose-lowering agents warranted further investigation.
This work aimed to investigate the associations between SGLT2is use vs dipeptidyl peptidase-4 inhibitors (DPP4is) use and 4 renal outcomes: end-stage renal disease (ESRD), albuminuria, acute renal failure (ARF), and the rate of estimated glomerular filtration rate (eGFR) change using a territory-wide electronic medical database in Hong Kong.
For this retrospective cohort study, the "prevalent new-user" design was adopted to account for previous exposure to study drugs. Propensity score matching was used to balance baseline characteristics. Electronic health data of type 2 diabetes patients using SGLT2is and DPP4is between 2015 and 2018 were collected.
The matched cohort consisted of 6333 SGLT2is users and 25 332 DPP4is users, with a median follow-up of 3.8 years. Compared to DPP4is, SGLT2is use was associated with lower risks of ESRD (hazard ratio [HR]: 0.51; 95% CI, 0.42-0.62; P < .001) and ARF (HR: 0.59; 95% CI, 0.48-0.73; P < .001), and a slower decline in eGFR. The associations remained statistically significant among patients with or without rapid eGFR decline and patients who added or switched to SGLT2is from DPP4is. The association with albuminuria was inconsistent across analyses.
Compared to DPP4is, SGLT2is use was associated with reduced risks of ESRD and ARF, and a slower eGFR decline in a real-world setting. The associations remained statistically significant in patients with or without preindex rapid eGFR decline.
糖尿病肾病是糖尿病患者的主要负担。钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2is）在临床试验和真实世界研究中显示可降低肾脏结局。然而，与各类降糖药物的头对头比较仍需要进一步研究。
本研究旨在使用香港全港范围内的电子病历数据库，调查 SGLT2is 与二肽基肽酶-4 抑制剂（DPP4is）的使用与 4 项肾脏结局之间的关联：终末期肾病（ESRD）、蛋白尿、急性肾损伤（ARF）和估算肾小球滤过率（eGFR）变化率。
这项回顾性队列研究采用“现患新用户”设计，以考虑研究药物的既往暴露情况。采用倾向评分匹配来平衡基线特征。收集了 2015 年至 2018 年期间使用 SGLT2is 和 DPP4is 的 2 型糖尿病患者的电子健康数据。
匹配队列包括 6333 名 SGLT2is 用户和 25332 名 DPP4is 用户，中位随访时间为 3.8 年。与 DPP4is 相比，SGLT2is 治疗与 ESRD（风险比 [HR]：0.51；95%CI，0.42-0.62；P<0.001）和 ARF（HR：0.59；95%CI，0.48-0.73；P<0.001）风险降低以及 eGFR 下降速度减慢相关。在快速 eGFR 下降的患者和从 DPP4is 转换为 SGLT2is 的患者中，这些关联仍然具有统计学意义。与蛋白尿的关联在各项分析中并不一致。
与 DPP4is 相比，SGLT2is 治疗与真实世界环境中 ESRD 和 ARF 风险降低以及 eGFR 下降速度减慢相关。在有或无指数前快速 eGFR 下降的患者中，这些关联仍然具有统计学意义。
