5期慢性肾脏病（CKD V）中钠-葡萄糖协同转运蛋白2抑制剂相关的心脏肾脏结局：一项倾向评分匹配分析。

Cardiorenal outcomes associated with sodium-glucose co-transporter-2 inhibitors in chronic kidney disease stage 5 (CKD V): A propensity score-matched analysis.

作者信息

Anuforo Anderson, Soipe Ayorinde, Awoyemi Toluwalase, Hanif Muhammad, Adeniran Olanrewaju, Somerville Alex, Nnekachi Nnokam, Chilaka Franklin, Aronow Wilbert, Yandrapalli Srikanth

机构信息

SUNY Upstate Medical University, Upstate Heart and Vascular Institute, Division of Cardiology, Syracuse, NY, United States of America.

SUNY Upstate Medical University, Department of Medicine, Syracuse, NY, United States of America.

出版信息

Int J Cardiol. 2025 Mar 1;422:132914. doi: 10.1016/j.ijcard.2024.132914. Epub 2024 Dec 19.

DOI:10.1016/j.ijcard.2024.132914

PMID:39708903

Abstract

BACKGROUND

There remains a paucity of data regarding the cardio-renal benefits of sodium-glucose co-transporter-2 inhibitors (SGLT2i) in patients with chronic kidney disease stage 5 (CKD V) based on major clinical trials.

OBJECTIVE

This retrospective study aimed to identify potential cardiovascular and renal outcomes associated with SGLT2i use in CKD V patients.

METHODS

We queried the TriNetX Global collaborative network from Jan 2014 - Aug 2023 for patients ≥18 years diagnosed with CKD V but not on dialysis. Patients were stratified based on SGLT2i use. Propensity score matching for sociodemographics, comorbidities, and medication use resulted in 3465 patients in each cohort. The primary outcome was a composite of all-cause mortality, progression to end-stage renal disease (ESRD), or heart failure (HF). Secondary outcomes were ESRD, heart failure, all-cause mortality, acute myocardial infarction (AMI), ischemic stroke, cardiac arrest, hypertensive urgency, and hypertensive crisis. Cox proportional HRs were used to compare outcomes over a 5-year follow-up period.

RESULTS

The SGLT2i cohort was associated with a significantly lower risk of the primary composite outcome (HR 0.644; 95 % CI: 0.601-0.733, p < 0.0001). SGLT2i use was also associated with lower risks of some secondary outcomes including all-cause mortality (HR 0.649; 0.587-0.717, p < 0.0001), ESRD (HR 0.597; 0.547-0.652, p < 0.0001), heart failure (HR 0.726; 0.625-0.844, p < 0.0001), development of AMI (0.649; 0.542-0.776, p < 0.0001), cardiac arrest (HR 0.595; 0.462-0.766, p < 0.0001), hypertensive urgency (HR 0.578; 0.3451-0.740, p < 0.0001), and hypertensive crisis (HR 0.603; 0.481-0.755, p < 0.0001).

CONCLUSION

Among CKD V patients, SGLT2i was associated with a significantly slowed progression of CKD to ESRD and reduced cardiac morbidity and mortality.

摘要

背景

基于主要临床试验，关于钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对5期慢性肾脏病（CKD V）患者心肾获益的数据仍然匮乏。

目的

这项回顾性研究旨在确定CKD V患者使用SGLT2i潜在的心血管和肾脏结局。

方法

我们在2014年1月至2023年8月期间查询了TriNetX全球合作网络，纳入年龄≥18岁、诊断为CKD V但未接受透析的患者。根据SGLT2i的使用情况对患者进行分层。对社会人口统计学、合并症和药物使用进行倾向评分匹配后，每个队列有3465例患者。主要结局是全因死亡率、进展至终末期肾病（ESRD）或心力衰竭（HF）的复合结局。次要结局包括ESRD、心力衰竭、全因死亡率、急性心肌梗死（AMI）、缺血性卒中、心脏骤停、高血压急症和高血压危象。使用Cox比例风险比来比较5年随访期内的结局。

结果

SGLT2i队列与主要复合结局的风险显著降低相关（风险比0.644；95%置信区间：0.601-0.733，p<0.0001）。使用SGLT2i还与一些次要结局的风险降低相关，包括全因死亡率（风险比0.649；0.587-0.717，p<0.0001）、ESRD（风险比0.597；0.547-0.652，p<0.0001）、心力衰竭（风险比0.726；0.625-0.844，p<0.0001）、AMI发生（0.649；0.542-0.776，p<0.0001）、心脏骤停（风险比0.595；0.462-0.766，p<0.0001）、高血压急症（风险比0.578；0.3451-0.740，p<0.0001）和高血压危象（风险比0.603；0.481-0.755，p<0.0001）。