Kidney Outcomes with GLP-1RAs, SGLT2 Inhibitors, DPP-4 Inhibitors, and Sulfonylureas in Type 2 Diabetes and Moderate Cardiovascular Risk

IF 8.5 1区医学 Q1 UROLOGY & NEPHROLOGY

Clinical Journal of the American Society of Nephrology Pub Date : 2024-10-08 DOI:10.2215/cjn.0000000587

Joshua J. Neumiller, Jeph Herrin, Kavya Sindhu Swarna, Eric C. Polley, Rodolfo J. Galindo, Guillermo E. Umpierrez, Yihong Deng, Joseph S. Ross, Mindy M. Mickelson, Rozalina G. McCoy

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引用次数: 0

Abstract

ly initiation of these agents relative to other commonly prescribed glucose-lowering agents in patients at lower baseline cardiovascular disease (CVD) risk remains less clear. Methods: This retrospective observational study emulated an idealized target trial using claims data from OptumLabs® Data Warehouse to test the comparative association of treatment with a dipeptidyl peptidase-4 (DPP-4) inhibitor, SGLT2 inhibitor, GLP-1 receptor agonist, or sulfonylurea on a primary kidney composite outcome of incident CKD stages 3-5, kidney failure, or need for kidney replacement therapy (KRT) in patients with type 2 diabetes (T2D) and moderate CVD risk. A secondary composite outcome included all components of the primary composite outcome plus death. Results: A total of 364,714 adults ≥21 years of age initiating treatment with a DPP-4 inhibitor (N=78,843), GLP-1 receptor agonist (N=42,049), SGLT2 inhibitor (N=45,466), or sulfonylurea (N=198,356) were identified. Relative to DPP-4 inhibitor, SGLT2 inhibitor (HR: 0.71; 95% CI: 0.67-0.74; P˂0.001) and GLP-1 receptor agonist (HR: 0.87; 95% CI: 0.83-0.92; P˂0.001) treatment was superior for the primary composite outcome. Similarly, SGLT2 inhibitor (HR: 0.69; CI: 0.66-0.73) and GLP-1 receptor agonist (HR: 0.86; CI: 0.82-0.91) treatment was associated with risk reductions for the primary outcome relative to sulfonylurea treatment. When comparing SGLT2 inhibitor to GLP-1 receptor agonist therapy, SGLT2 inhibitors were superior for the primary composite outcome (HR: 0.81; 95% CI: 0.75-0.76; P˂0.001). Similar findings were observed for the secondary composite outcome across all comparisons. Conclusions: SGLT2 inhibitors and GLP-1 receptor agonists were superior to DPP-4 inhibitors and sulfonylurea for preventing kidney complications in a T2D population with moderate baseline CVD risk. Copyright © 2024 by the American Society of Nephrology...

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中度心血管风险的 2 型糖尿病患者使用 GLP-1RA、SGLT2 抑制剂、DPP-4 抑制剂和磺脲类药物治疗肾脏的结果

在心血管疾病（CVD）基线风险较低的患者中，相对于其他常用降糖药物，是否开始使用这些药物仍然不太清楚。方法：这项回顾性观察研究利用 OptumLabs® 数据仓库的理赔数据模拟了一个理想化的目标试验，以检验二肽基肽酶-4 (DPP-4) 抑制剂、SGLT2 抑制剂、GLP-1 受体激动剂或磺脲类药物的治疗与 2 型糖尿病 (T2D) 和中度心血管疾病风险患者的主要肾脏综合结果（CKD 3-5 期、肾衰竭或需要肾脏替代治疗 (KRT)）之间的比较关系。次要综合结果包括主要综合结果的所有组成部分以及死亡。研究结果共有 364,714 名年龄≥21 岁的成人开始接受 DPP-4 抑制剂（N=78,843）、GLP-1 受体激动剂（N=42,049）、SGLT2 抑制剂（N=45,466）或磺脲类药物（N=198,356）治疗。与 DPP-4 抑制剂相比，SGLT2 抑制剂（HR：0.71；95% CI：0.67-0.74；P˂0.001）和 GLP-1 受体激动剂（HR：0.87；95% CI：0.83-0.92；P˂0.001）治疗的主要复合结局更优。同样，相对于磺脲类药物治疗，SGLT2 抑制剂（HR：0.69；CI：0.66-0.73）和 GLP-1 受体激动剂（HR：0.86；CI：0.82-0.91）治疗与主要结局风险降低相关。在比较 SGLT2 抑制剂和 GLP-1 受体激动剂治疗时，SGLT2 抑制剂在主要复合结局方面更具优势（HR：0.81；95% CI：0.75-0.76；P˂0.001）。在所有比较中，对次要综合结果也观察到了类似的结果。结论对于具有中等心血管疾病基线风险的 T2D 患者，SGLT2 抑制剂和 GLP-1 受体激动剂在预防肾脏并发症方面优于 DPP-4 抑制剂和磺脲类药物。版权所有 © 2024 年美国肾脏病学会...

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来源期刊

Clinical Journal of the American Society of Nephrology 医学-泌尿学与肾脏学

CiteScore

12.20

自引率

3.10%

发文量

514

审稿时长

3-6 weeks

期刊介绍： The Clinical Journal of the American Society of Nephrology strives to establish itself as the foremost authority in communicating and influencing advances in clinical nephrology by (1) swiftly and effectively disseminating pivotal developments in clinical and translational research in nephrology, encompassing innovations in research methods and care delivery; (2) providing context for these advances in relation to future research directions and patient care; and (3) becoming a key voice on issues with potential implications for the clinical practice of nephrology, particularly within the United States. Original manuscript topics cover a range of areas, including Acid/Base and Electrolyte Disorders, Acute Kidney Injury and ICU Nephrology, Chronic Kidney Disease, Clinical Nephrology, Cystic Kidney Disease, Diabetes and the Kidney, Genetics, Geriatric and Palliative Nephrology, Glomerular and Tubulointerstitial Diseases, Hypertension, Maintenance Dialysis, Mineral Metabolism, Nephrolithiasis, and Transplantation.