Exploring the mortality and cardiovascular outcomes with SGLT-2 inhibitors in patients with T2DM at dialysis commencement: a health global federated network analysis.

IF 8.5 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Chung-An Wang, Li-Chun Lin, Jui-Yi Chen, Wei-Jie Wang, Vin-Cent Wu
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引用次数: 0

Abstract

Background: Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) have demonstrated associations with lowering cardiovascular outcomes in patients with type 2 diabetes mellitus (T2DM). However, the impact of SGLT-2is on individuals at dialysis commencement remains unclear. The aim of this real-world study is to study the association between SGLT-2is and outcomes in patients with T2DM at dialysis commencement.

Methods: This is a retrospective cohort study of electronic health records (EHRs) of patients with T2DM from TriNetX Research Network database between January 1, 2012, and January 1, 2024. New-users using intention to treatment design was employed and propensity score matching was utilized to select the cohort. Clinical outcomes included major adverse cardiac events (MACE) and all-cause mortality. Safety outcomes using ICD-10 codes, ketoacidosis, urinary tract infection (UTI) or genital infection, dehydration, bone fracture, below-knee amputation, hypoglycemia, and achieving dialysis-free status at 90 days and 90-day readmission.

Results: Of 49,762 patients with T2DM who initiated dialysis for evaluation, a mere 1.57% of patients utilized SGLT-2is within 3 months after dialysis. 771 SGLT-2i users (age 63.3 ± 12.3 years, male 65.1%) were matched with 771 non-users (age 63.1 ± 12.9 years, male 65.8%). After a median follow-up of 2.0 (IQR 0.3-3.9) years, SGLT-2i users were associated with a lower risk of MACE (adjusted Hazard Ratio [aHR] = 0.52, p value < 0.001), all-cause mortality (aHR = 0.49, p < 0.001). SGLT-2i users were more likely to become dialysis-free 90 days after the index date (aHR = 0.49, p < 0.001). No significant differences were observed in the incidence of ketoacidosis, UTI or genital infection, hypoglycemia, dehydration, bone fractures, below-knee amputations, or 90-day readmissions.

Conclusions: Our findings indicated a lower incidence of all-cause mortality and MACE after long-term follow-up, along with a higher likelihood of achieving dialysis-free status at 90 days in SGLT-2i users. Importantly, they underscored the potential cardiovascular protection and safety of SGLT-2is use in T2DM patients at the onset of dialysis.

探索开始透析时使用 SGLT-2 抑制剂的 T2DM 患者的死亡率和心血管后果:健康全球联合网络分析。
背景:钠-葡萄糖共转运体 2 抑制剂(SGLT-2is)已证明可降低 2 型糖尿病(T2DM)患者的心血管后果。然而,SGLT-2is 对开始透析患者的影响仍不清楚。这项真实世界研究旨在研究 SGLT-2is 与开始透析的 T2DM 患者的预后之间的关系:这是一项回顾性队列研究,研究对象是 2012 年 1 月 1 日至 2024 年 1 月 1 日期间 TriNetX 研究网络数据库中 T2DM 患者的电子健康记录(EHR)。研究采用了新用户意向治疗设计和倾向得分匹配来选择队列。临床结果包括主要心脏不良事件(MACE)和全因死亡率。安全结果包括ICD-10编码、酮症酸中毒、尿路感染(UTI)或生殖器感染、脱水、骨折、膝下截肢、低血糖、90天无透析状态和90天再入院:在 49,762 名接受透析评估的 T2DM 患者中,仅有 1.57% 的患者在透析后 3 个月内使用了 SGLT-2i。771 名使用 SGLT-2i 的患者(年龄为 63.3 ± 12.3 岁,男性占 65.1%)与 771 名未使用 SGLT-2i 的患者(年龄为 63.1 ± 12.9 岁,男性占 65.8%)进行了配对。中位随访 2.0(IQR 0.3-3.9)年后,SGLT-2i 使用者的 MACE 风险较低(调整后危险比 [aHR] = 0.52,P 值 结论:SGLT-2i 使用者的 MACE 风险较低:我们的研究结果表明,长期随访后,SGLT-2i 使用者的全因死亡率和 MACE 发生率较低,90 天后达到无透析状态的可能性较高。重要的是,他们强调了在开始透析的 T2DM 患者中使用 SGLT-2i 潜在的心血管保护和安全性。
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来源期刊
Cardiovascular Diabetology
Cardiovascular Diabetology 医学-内分泌学与代谢
CiteScore
12.30
自引率
15.10%
发文量
240
审稿时长
1 months
期刊介绍: Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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