在英国临床环境中，与二肽基肽酶-4 抑制剂相比，钠-葡萄糖共转运蛋白-2 抑制剂可显著减少 2 型糖尿病成人的慢性肾脏病进展：基于肾脏病国际指南的观察性结局研究。
Significant reduction in chronic kidney disease progression with sodium-glucose cotransporter-2 inhibitors compared to dipeptidyl peptidase-4 inhibitors in adults with type 2 diabetes in a UK clinical setting: An observational outcomes study based on international guidelines for kidney disease.
机构信息
Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Royal Derby Hospital, Derby, UK.
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
出版信息
Diabetes Obes Metab. 2022 Nov;24(11):2138-2147. doi: 10.1111/dom.14799. Epub 2022 Jul 6.
AIMS
To confirm the reno-protective effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors compared with dipeptidyl peptidase-4 (DPP-4) inhibitors on the onset and progression of chronic kidney disease (CKD) in routine clinical practice.
MATERIALS AND METHODS
We conducted a retrospective cohort study using the Clinical Practice Research Datalink Aurum database linked to Hospital Episode Statistics. The primary outcome was risk of the composite CKD endpoint based on the recent consensus guidelines for kidney disease: >40% decline in estimated glomerular filtration rate (eGFR), kidney death or end-stage kidney disease (ESKD; a composite of kidney transplantation, maintenance of dialysis, sustained low eGFR <15 ml/min/1.73m² or diagnosis of ESKD). Secondary outcomes were components of the composite CKD endpoint, analysed separately. Patients were propensity-score-matched 1:1 for SGLT2 inhibitor versus DPP-4 inhibitor use.
RESULTS
A total of 131 824 people with type 2 diabetes (T2D) were identified; 79.0% had no known history of CKD. During a median follow-up of 2.1 years, SGLT2 inhibitor initiation was associated with lower risk of progression to composite kidney endpoints than DPP-4 inhibitor initiation (7.48 vs. 11.77 events per 1000 patient-years, respectively). Compared with DPP-4 inhibitor initiation, SGLT2 inhibitor initiation was associated with reductions in the primary composite CKD endpoint (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.56-0.74), all-cause mortality (HR 0.74, 95% CI 0.64-0.86) and ESKD (HR 0.37, 95% CI 0.25-0.55), reduced the rate of sustained low eGFR (HR 0.33, 95% CI 0.19-0.57), and reduced diagnoses of ESKD in primary care (HR 0.04, 95% CI 0.01-0.18). Results were consistent across subgroup and sensitivity analyses.
CONCLUSIONS
In adults with T2D, initiation of an SGLT2 inhibitor was associated with a significantly reduced risk of CKD progression and death compared with initiation of a DPP-4 inhibitor.
目的
在常规临床实践中，确认钠-葡萄糖共转运蛋白-2（SGLT2）抑制剂相对于二肽基肽酶-4（DPP-4）抑制剂在慢性肾脏病（CKD）的发生和进展方面的肾保护作用。
材料和方法
我们使用临床实践研究数据链接至医院入院统计的 Aurum 数据库进行了回顾性队列研究。主要结局是根据最近的肾脏疾病共识指南，基于估算肾小球滤过率（eGFR）下降>40%、肾脏死亡或终末期肾病（ESKD；包括肾脏移植、维持透析、持续低 eGFR<15 ml/min/1.73m²或诊断为 ESKD）的复合 CKD 终点的风险。分别分析次要结局为复合 CKD 终点的组成部分。对 SGLT2 抑制剂与 DPP-4 抑制剂使用的患者进行了 1:1 的倾向评分匹配。
结果
共纳入 131824 例 2 型糖尿病（T2D）患者；79.0%无已知 CKD 病史。在中位随访 2.1 年期间，与 DPP-4 抑制剂起始治疗相比，SGLT2 抑制剂起始治疗与复合肾脏终点进展的风险较低（分别为每 1000 患者年 7.48 例和 11.77 例）。与 DPP-4 抑制剂起始治疗相比，SGLT2 抑制剂起始治疗与主要复合 CKD 终点（风险比 [HR] 0.64，95%置信区间 [CI] 0.56-0.74）、全因死亡率（HR 0.74，95%CI 0.64-0.86）和 ESKD（HR 0.37，95%CI 0.25-0.55）的降低相关，降低了持续低 eGFR 的发生率（HR 0.33，95%CI 0.19-0.57），并降低了初级保健中 ESKD 的诊断（HR 0.04，95%CI 0.01-0.18）。亚组和敏感性分析结果一致。
结论
在患有 T2D 的成年人中，与起始 DPP-4 抑制剂相比，起始 SGLT2 抑制剂与 CKD 进展和死亡风险显著降低相关。
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