Effects of sodium-glucose cotransporter-2 inhibitors on chronic kidney disease progression: a multi-state survival model.

IF 3.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetology & Metabolic Syndrome Pub Date : 2024-11-23 DOI:10.1186/s13098-024-01522-6

Amarit Tansawet, Panu Looareesuwan, Htun Teza, Sarinya Boongird, Gareth J McKay, John Attia, Oraluck Pattanaprateep, Ammarin Thakkinstian

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引用次数: 0

Abstract

Background: Current guidelines recommend good glycemic control in patients with type 2 diabetes (T2D) to limit the progression of associated complications with combination therapies. This study aimed to compare the rate of chronic kidney disease (CKD) progression between patients who did or did not receive sodium-glucose cotransporter-2 inhibitors (SGLT2i) using a multistate model with two intermediate states (i.e., CKD stage 4 (CKD4) and 5 (CKD5)) and one absorbing state (i.e., death).

Methods: Data from patients with T2D and CKD stage 3 (CKD3) were retrieved for analysis. Patients treated with SGLT2i were matched 1:2 by prescription date with non-SGLT2i patients. The multistate model was constructed from Cox survival regression models specific to each transition stage. Cumulative failure and transition probabilities were estimated from bootstrapping.

Results: Data from 6582 patients (2194 and 4388 patients in the SGLT2i and non-SGLT2i groups, respectively) were analyzed. At 10-year follow-up, patients in the SGLT2i group were more likely to remain at CKD3 compared to the non-SGLT2i group: 82.3% (95% CI 79.9%, 84.6%) vs 60.4% (57.6%, 63.4%). Transition probabilities to CKD4, CKD5, and death were lower in the SGLT2i group than non-SGLT2i group: 11.3% (9.5%, 13.3%) vs 19.8% (17.4%, 22.2%), 2.4% (1.5%, 3.4%) vs 7.4% (5.8%, 9.0%), and 4.1% (2.9%, 5.3%) vs 12.4% (10.3%, 14.6%), respectively.

Conclusion: SGLT2i may delay the decline in renal function and slow CKD progression compared to standard care without SGLT2i.

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钠-葡萄糖共转运体-2 抑制剂对慢性肾病进展的影响：多状态生存模型。

背景：现行指南建议2型糖尿病（T2D）患者做好血糖控制，以限制联合疗法相关并发症的发展。本研究旨在使用一个多状态模型，比较接受或未接受钠-葡萄糖共转运体-2抑制剂（SGLT2i）治疗的患者的慢性肾病（CKD）进展率，该模型包含两个中间状态（即CKD4期（CKD4）和5期（CKD5））和一个吸收状态（即死亡）：方法：检索 T2D 和 CKD 3 期（CKD3）患者的数据进行分析。接受 SGLT2i 治疗的患者与非 SGLT2i 患者按处方日期 1:2 配对。多态模型由针对每个转归阶段的 Cox 生存回归模型构建而成。累积失败概率和转归概率由引导法估算得出：分析了 6582 名患者（SGLT2i 组和非 SGLT2i 组分别有 2194 名和 4388 名患者）的数据。在 10 年的随访中，与非 SGLT2i 组相比，SGLT2i 组患者更有可能停留在 CKD3 阶段：82.3% (95% CI 79.9%, 84.6%) vs 60.4% (57.6%, 63.4%)。SGLT2i 组患者转为 CKD4、CKD5 和死亡的概率低于非 SGLT2i 组：分别为11.3%（9.5%，13.3%）vs 19.8%（17.4%，22.2%）、2.4%（1.5%，3.4%）vs 7.4%（5.8%，9.0%）和4.1%（2.9%，5.3%）vs 12.4%（10.3%，14.6%）：结论：与不使用 SGLT2i 的标准疗法相比，SGLT2i 可延缓肾功能衰退，减缓 CKD 进展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetology & Metabolic Syndrome ENDOCRINOLOGY & METABOLISM-

CiteScore

6.20

自引率

0.00%

发文量

170

审稿时长

7.5 months

期刊介绍： Diabetology & Metabolic Syndrome publishes articles on all aspects of the pathophysiology of diabetes and metabolic syndrome. By publishing original material exploring any area of laboratory, animal or clinical research into diabetes and metabolic syndrome, the journal offers a high-visibility forum for new insights and discussions into the issues of importance to the relevant community.