Victoria Socha

DocwireNews

Recommendations from current guidelines call for the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors independently of glycemic control in patients with type 2 diabetes as well as those with chronic kidney disease, heart failure, or at high risk of cardiovascular disease.Researchers in Israel, led by Meltzer Cohen, MD, conducted a study designed to examine the association between long-term use of SGLT2 inhibitors versus dipeptidyl peptidase 4 (DPP4) inhibitors and kidney benefits in patients with type 2 diabetes as well as in a subgroup without evidence of cardiovascualr or kidney disease. Results of the study were reported in the Clinical Journal of the American Society of Nephrology.Using a large Israeli database, the researchers propensity score-matched patients with type 2 diabetes who initiated SGLT2 inhibitors or DPP4 inhibitors between 2015 and 2021 1:1 according to 90 parameters. The primary outcome of interest was a kidney-specific composite outcome of confirmed &ge;40% decline in estimated glomerular filtration rate (eGFR) or kidney failure. The kidney-or-death outcome included all-cause mortality.Cox proportional hazard regression models were used to assess the risks of outcomes. The between-group difference in eGFR slope was also examined. Analyses were repeated in the subgroup of patients without evidence of cardiovascular or kidney diseaseA total of 19,648 propensity score-matched patients were included. Of those 53% (n=10,467) had no evidence of cardiovascular or kidney disease. Median follow-up was 38 months.The composite kidney-specific outcome occurred at an event rate of 6.9 events per 1000 patient-years with SLGT2 inhibitors versus 9.5 events per 1000 patient-years with DPP4 inhibitors. The event rates of the kidney-or-death outcome were 17.1 with SGLT2 inhibitors versus 22.1 with DPP4 inhibitors.Compared with DPP4 inhibitors, initiation of SGLT2 inhibitors was associated with a lower risk for both the kidney-specific outcome (hazard ratio [HR], 0.72; 95% CI, 0.61-0.86; P&lt;.001) and the kidney-or-death outcome (HR, 0.80; 95% CI, 0.71-0.89; P&lt;.001). In the subgroup of patients without evidence of cardiovascular or kidney disease, the respective HRs were 0.67 (95% CI, 0.44-1.02) and 0.77 (95% CI, 0.61-0.97).In the overall cohort, there was an association between initiation of SGLT2 inhibitors and a mitigation of the eGFR slope compared with initiation of DPP4 inhibitors. The association remained in the subgroup of patients without evidence of cardiovascular or kidney disease.In conclusion, the authors said, &ldquo;Long-term use of SGLT2 inhibitors versus DPP4 inhibitors in a real-world setting was associated with mitigation of eGFR loss in patients with type 2 diabetes, even in those lacking evidence of cardiovascular or kidney disease at baseline.&rdquo;&nbsp;Source: <a href="https://journals.lww.com/cjasn/fulltext/2023/09000/long_term,_real_world_kidney_outcomes_with_sglt2i.10.aspx" target="_blank" rel="noopener">Clinical Journal of the American Society of Nephrology</a>

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Renal Outcomes With SGLT2 Inhibitors in Patients With Type 2 Diabetes

Part of NephTimes Diseases and Conditions

Diabetes and Hypertension

Assessing the association between long-term use of SGLT2 inhibitors versus DPP4 inhibitors and kidney benefits in patients with type 2 diabetes.

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