4期和5期慢性肾脏病患者中钠-葡萄糖协同转运蛋白2抑制剂与二肽基肽酶4抑制剂的心血管和肾脏结局：一项基于人群的研究
Cardiovascular and renal outcomes between sodium-glucose cotransporter 2 inhibitors and dipeptidyl peptidase 4 inhibitors in patients with chronic kidney disease stages 4 and 5: a population-based study.
作者信息
Chen Tien-Hsing, Wang Te-Hsiung, Tsai Ming-Lung, Lin Ming-Shyan, Tsai Tzu-Hsien, Chou Tien-Shin, Tseng Chin-Ju, Dai Jhih-Wei, Cheng Chien-Wei, Yang Ning-I, Hung Ming-Jui, Lin Yuan
机构信息
Division of Cardiology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Department of Emergency Medicine, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Osaka, Japan; Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
出版信息
Diabetes Res Clin Pract. 2025 Jun;224:112205. doi: 10.1016/j.diabres.2025.112205. Epub 2025 Apr 26.
AIMS
Limited evidence exists regarding the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in cardiovascular and renal outcomes in patients with advanced chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) < 30 mL/min per 1.73 m.
METHODS
We enrolled patients with type 2 diabetes mellitus and eGFR < 30 mL/min per 1.73 m who were prescribed SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i) from 2016 to 2022 (n = 117,924). The primary cardiovascular outcomes included cardiovascular death, myocardial infarction, ischemic stroke, and heart failure-related admission. Renal outcomes encompassed an eGFR decline of >50 %, a doubling of serum creatinine levels, and progression to dialysis.
RESULTS
The study included 6,730 participants [SGLT2i, n = 1,086; DPP4i, n = 5,644]. In both groups, the composite cardiovascular events developed at a rate of 13.2 events per 100 person-years (PYs) [hazard ratio (HR), 0.92; 95 % confidence interval (CI) 0.71-1.19]. The composite of renal events occurred at a rate of 18.5 and 16.2 events per 100 PYs in the SGLT2i and DPP4i groups, respectively [subdistribution HR 1.12; 95 % CI 0.91-1.38].
CONCLUSIONS
Compared to DPP4i, SGLT2i did not show superiority in the reduction of cardiovascular or renal events in CKD stage 4-5 patients.
目的
关于钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）对估算肾小球滤过率（eGFR）<30 mL/（min·1.73 m²）的晚期慢性肾脏病（CKD）患者心血管和肾脏结局的益处，现有证据有限。
方法
我们纳入了2016年至2022年期间被处方使用SGLT2i或二肽基肽酶4抑制剂（DPP4i）的2型糖尿病且eGFR<30 mL/（min·1.73 m²）的患者（n = 117,924）。主要心血管结局包括心血管死亡、心肌梗死、缺血性卒中以及与心力衰竭相关的住院治疗。肾脏结局包括eGFR下降>50%、血清肌酐水平翻倍以及进展至透析。
结果
该研究纳入了6730名参与者[SGLT2i组，n = 1086；DPP4i组，n = 5644]。两组中，复合心血管事件的发生率均为每100人年13.2起事件[风险比（HR），0.92；95%置信区间（CI）0.71 - 1.19]。SGLT2i组和DPP4i组中肾脏事件的复合发生率分别为每100人年18.5起和16.2起事件[亚分布HR 1.12；95% CI 0.91 - 1.38]。
结论
与DPP4i相比，SGLT2i在降低4 - 5期CKD患者的心血管或肾脏事件方面未显示出优越性。
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