一项关于钠-葡萄糖协同转运蛋白2抑制剂与糖尿病肾病进展的真实世界研究。

A real-world study on SGLT2 inhibitors and diabetic kidney disease progression.

作者信息

Liu Allen Yan Lun, Low Serena, Yeoh Ester, Lim Eng Kuang, Renaud Claude Jeffrey, Teoh Selene Tse Yen, Tan Grace Feng Ling, Chai Chung Cheen, Liu Bo, Subramaniam Tavintharan, Sum Chee Fang, Lim Su Chi

机构信息

Department of General Medicine, Khoo Teck Puat Hospital, Singapore.

Clinical Research Unit, Khoo Teck Puat Hospital, Singapore.

出版信息

Clin Kidney J. 2022 Feb 16;15(7):1403-1414. doi: 10.1093/ckj/sfac044. eCollection 2022 Jul.

BACKGROUND

Randomized controlled trials have demonstrated the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2is) in people with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). However, real-world data on CKD progression and the development of end-stage kidney disease (ESKD) remains scarce. Our aim was to study renal outcomes of people with diabetic kidney disease (DKD) using SGLT2is in a highly prevalent DKD population.

METHODS

Between 2016 and 2019 we recruited T2DM patients in the renal and diabetic clinics in a regional hospital in Singapore. Patients prescribed SGLT2is were compared with those on standard anti-diabetic and renoprotective treatment. The outcome measures were CKD progression [ ≥25% decrease from baseline and worsening of estimated glomerular filtration rate (eGFR) categories according to the Kidney Disease: Improving Global Outcomes guidelines] and ESKD (eGFR <15 mL/min/1.73 m).

RESULTS

We analysed a total of 4446 subjects; 1598 were on SGLT2is. There was a significant reduction in CKD progression {hazard ratio [HR] 0.60 [95% confidence interval (CI) 0.49-0.74]} with SGLT2is. The HR for eGFR ≥45 mL/min/1.73 m and 15-44 mL/min/1.73 m was 0.60 (95% CI 0.47-0.76) and 0.43 (95% CI 0.23-0.66), respectively. There was also a reduction in risk for developing ESKD for the entire cohort [HR 0.33 (95% CI 0.17-0.65)] and eGFR 15-44 mL/min/1.73 m [HR 0.24 (95% CI 0.09-0.66)]. Compared with canagliflozin and dapagliflozin, empagliflozin showed a sustained risk reduction of renal outcomes across CKD stages 1-4.

CONCLUSIONS

This real-world study demonstrates the benefits of SGLT2is on CKD progression and ESKD. The effect is more pronounced in moderate to advanced CKD patients.

背景

随机对照试验已证明钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对2型糖尿病（T2DM）合并慢性肾脏病（CKD）患者有益。然而，关于CKD进展和终末期肾病（ESKD）发生的真实世界数据仍然稀缺。我们的目的是在高度流行的糖尿病肾病（DKD）人群中研究使用SGLT2i的DKD患者的肾脏结局。

方法

2016年至2019年期间，我们在新加坡一家地区医院的肾脏科和糖尿病科招募了T2DM患者。将开具SGLT2i的患者与接受标准抗糖尿病和肾脏保护治疗的患者进行比较。结局指标为CKD进展[根据改善全球肾脏病预后指南，与基线相比下降≥25%且估计肾小球滤过率（eGFR）类别恶化]和ESKD（eGFR<15 mL/min/1.73 m²）。

结果

我们共分析了4446名受试者；1598名使用SGLT2i。使用SGLT2i可使CKD进展显著降低{风险比[HR] 0.60 [95%置信区间（CI）0.49 - 0.74]}。eGFR≥45 mL/min/1.73 m²和15 - 44 mL/min/1.73 m²的HR分别为0.60（95% CI 0.47 - 0.76）和0.43（95% CI 0.23 - 0.66）。整个队列发生ESKD的风险也有所降低[HR 0.33（95% CI 0.17 - 0.65）]，eGFR为15 - 44 mL/min/1.73 m²时[HR 0.24（95% CI 0.09 - 0.66）]。与卡格列净和达格列净相比，恩格列净在CKD 1 - 4期均持续降低肾脏结局风险。