Idris, Iskandar;
Zhang, Ruiqi;
Mamza, Jil B;
Ford, Mike;
Morris, Tamsin;
Banerjee, Amitava;
Khunti, Kamlesh;
(2022)
Significant reduction in chronic kidney disease progression with sodium glucose co-transporter-2 inhibitors compared to dipeptidyl peptidase-4 inhibitors in adults with type 2 diabetes in UK clinical setting: An observational outcomes study based on international guidelines for kidney disease.
Diabetes, Obesity and Metabolism
, 24
(11)
pp. 2138-2147.
10.1111/dom.14799.
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Abstract
AIMS: This observational study aims to confirm the reno-protective effects of sodium-glucose co-transporter-2 inhibitors (SGLT2i) compared with dipeptidyl peptidase-4 inhibitors (DPP4i) on the onset and progression of chronic kidney disease (CKD) in a routine clinical practice. MATERIALS AND METHODS: This was a retrospective cohort study using the Clinical Practice Research Datalink Aurum database linked to Hospital Episode Statistics. The primary outcome was risk of the composite CKD endpoints based on the recent consensus guidelines for kidney disease: >40% decline in estimated glomerular filtration rate, kidney death or end-stage kidney disease (ESKD; a composite of kidney transplantation, maintenance of dialysis, sustained low eGFR<15 or diagnosis of ESKD). Secondary outcomes were the components of the composite CKD endpoint analyzed separately. Patients were propensity score-matched 1:1 for SGLT2i vs DPP4i. RESULTS: 131,824 people with type 2 diabetes were identified; 79.0% had no known history of CKD. During a median follow-up of 2.1 years, SGLT-2i initiation was associated with lower risk of progression to composite kidney endpoints than DPP-4i (7.48 and 11.77 events per 1000 patient-years respectively). Compared with DPP-4i, SGLT-2i initiation was associated with reductions in the primary composite CKD endpoint (hazard ratio 0.64; 95% confidence interval 0.56-0.74), all-cause mortality (0.74; 0.64-0.86) and end-stage kidney disease (ESKD; 0.37; 0.25-0.55); reduced the rate of sustained low eGFR (0.33; 0.19-0.57); and reduced diagnoses of ESKD in primary care (0.04; 0.01-0.18). Results were consistent across subgroup and sensitivity analyses. CONCLUSIONS: In adults with type 2 diabetes, initiation of SGLT-2i was associated with a significantly reduced risk of CKD progression and death compared with initiation of DPP-4i. This article is protected by copyright. All rights reserved.
| Type: | Article |
|---|---|
| Title: | Significant reduction in chronic kidney disease progression with sodium glucose co-transporter-2 inhibitors compared to dipeptidyl peptidase-4 inhibitors in adults with type 2 diabetes in UK clinical setting: An observational outcomes study based on international guidelines for kidney disease |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1111/dom.14799 |
| Publisher version: | https://doi.org/10.1111/dom.14799 |
| Language: | English |
| Additional information: | © 2022 The Authors. Diabetes, Obesity and Metabolism published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. |
| Keywords: | diabetes complications, DPP4 inhibitor, observational study, population study, SGLT2 inhibitor, type 2 diabetes |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10150580 |
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