Weng Yi-Fang, Chen Chung-Yu, Hwang Shang-Jyh, Huang Yaw-Bin
Master Degree Program in Clinical Pharmacy, School of Pharmacy, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Pharmacy, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan.
Kaohsiung J Med Sci. 2023 Apr;39(4):416-425. doi: 10.1002/kjm2.12635. Epub 2023 Jan 10.
Previous studies about renal protection of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) patients with heart failure (HF) on diuretics were still limited. The goal of the study is to survey the efficacy of SGLT2i to reduce all-cause mortality and renal impairments in patients with T2DM and HF using diuretics. The retrospective cohort study was analyzed from Kaohsiung Medical University Hospital Research Database (KMUHRD) in Taiwan. Adults with T2DM and HF using any diuretics at least 28 days during 2016-2018 were enrolled and then divided into the SGLT2i group and the non-SGLT2i group. Propensity score matching was used to balance baseline characteristics between the two groups. The primary outcome was all-cause mortality. Secondary outcomes contained dialysis occurrence, renal progression, and acute kidney injury (AKI). After 1:1 matching, there were 183 patients in each group respectively. When compared with the non-SGLT2i group, the SGLT2i group had significantly lower all-cause mortality (hazard ratios [HR]: 0.49, 95% CI 0.29-0.83, p = 0.008) and reduction of renal progression (HR: 0.30, 95% CI 0.12-0.75, p = 0.010). SGLT2i showed the trend to decrease dialysis occurrence (HR: 0.83, 95% CI 0.20-3.47, p = 0.797) and an increase in AKI (HR: 1.38, 95% CI 0.67-2.87, p = 0.383) but without significance. SGLT2 inhibitors were associated with reduced all-cause mortality and less renal progression with significance in T2DM patients with HF on diuretics.
既往关于钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对使用利尿剂的2型糖尿病（T2DM）合并心力衰竭（HF）患者肾脏保护作用的研究仍然有限。本研究的目的是探讨SGLT2i对使用利尿剂的T2DM合并HF患者降低全因死亡率和肾脏损害的疗效。本回顾性队列研究分析了台湾高雄医学大学医院研究数据库（KMUHRD）。纳入2016年至2018年期间使用任何利尿剂至少28天的T2DM合并HF的成年人，然后分为SGLT2i组和非SGLT2i组。采用倾向评分匹配法平衡两组的基线特征。主要结局是全因死亡率。次要结局包括透析发生率、肾脏进展和急性肾损伤（AKI）。经过1:1匹配后，每组分别有183例患者。与非SGLT2i组相比，SGLT2i组的全因死亡率显著降低（风险比[HR]：0.49，95%置信区间0.29-0.83，p = 0.008），肾脏进展减少（HR：0.30，95%置信区间0.12-0.75，p = 0.010）。SGLT2i有降低透析发生率的趋势（HR：0.83，95%置信区间0.20-3.47，p = 0.797），AKI增加（HR：1.38，95%置信区间0.67-2.87，p = 0.383），但无统计学意义。在使用利尿剂的T2DM合并HF患者中，SGLT2抑制剂与降低全因死亡率和减少肾脏进展显著相关。
