Kobayashi Kazuo, Toyoda Masao, Hatori Nobuo, Tsukamoto Shunichiro, Kimura Moritsugu, Sakai Hiroyuki, Furuki Takayuki, Chin Keiichi, Kanaoka Tomohiko, Aoyama Togo, Umezono Tomoya, Ito Shun, Suzuki Daisuke, Takeda Hiroshi, Degawa Hisakazu, Hishiki Toshimasa, Shimura Hidetoshi, Nakajima Shinichi, Miyauchi Masaaki, Yamamoto Hareaki, Hatori Yutaka, Hayashi Masahiro, Sato Kazuyoshi, Miyakawa Masaaki, Terauchi Yasuo, Tamura Kouichi, Kanamori Akira
Committee of Hypertension and Kidney Disease, Kanagawa Physicians Association.
Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama.
Cardiovasc Endocrinol Metab. 2023 Sep 28;12(4):e0292. doi: 10.1097/XCE.0000000000000292. eCollection 2023 Dec.
This study aimed to clarify the renal influence of glucagon-like peptide 1 receptor agonists (GLP1Ras) with or without sodium-glucose co-transporter 2 inhibitors (SGLT2is) on Japanese patients with type 2 diabetes mellitus (T2DM).
We retrospectively extracted 547 patients with T2DM who visited the clinics of members of Kanagawa Physicians Association. The progression of albuminuria status and/or a ≥ 15% decrease in the estimated glomerular filtration rate (eGFR) per year was set as the renal composite outcome. Propensity score matching was performed to compare GLP1Ra-treated patients with and without SGLT2i.
After matching, 186 patients in each group were compared. There was no significant difference of the incidence of the renal composite outcomes (17% vs. 20%, = 0.50); however, the annual decrease in the eGFR was significantly smaller and the decrease in the urine albumin-to-creatinine ratio was larger in GLP1Ra-treated patients with the concomitant use of SGLT2is than in those without it (-1.1 ± 5.0 vs. -2.8 ± 5.1 mL/min/1.73 m, = 0.001; and -0.08 ± 0.61 vs. 0.05 ± 0.52, = 0.03, respectively).
The concomitant use of SGLT2i with GLP1Ra improved the annual decrease in the eGFR and the urine albumin-to-creatinine ratio in Japanese patients with T2DM.
本研究旨在阐明胰高血糖素样肽1受体激动剂（GLP1Ras）联合或不联合钠-葡萄糖协同转运蛋白2抑制剂（SGLT2is）对日本2型糖尿病（T2DM）患者肾脏的影响。
我们回顾性提取了547例就诊于神奈川医师协会成员诊所的T2DM患者。将蛋白尿状态进展和/或每年估计肾小球滤过率（eGFR）下降≥15%设定为肾脏复合结局。进行倾向评分匹配，以比较接受GLP1Ra治疗且使用或未使用SGLT2i的患者。
匹配后，对每组186例患者进行比较。肾脏复合结局的发生率无显著差异（17%对20%，P = 0.50）；然而，与未联合使用SGLT2is的患者相比，联合使用SGLT2is的GLP1Ra治疗患者的eGFR年下降幅度显著更小，尿白蛋白与肌酐比值下降幅度更大（分别为-1.1±5.0对-2.8±5.1 mL/min/1.73 m²，P = 0.001；以及-0.08±0.61对0.05±0.52，P = 0.03）。
在日本T2DM患者中，SGLT2i与GLP1Ra联合使用改善了eGFR年下降幅度和尿白蛋白与肌酐比值。
