Cardiovascular and renal outcomes between sodium-glucose cotransporter 2 inhibitors and dipeptidyl peptidase 4 inhibitors in patients with chronic kidney disease stages 4 and 5: a population-based study

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-04-26 DOI:10.1016/j.diabres.2025.112205

Tien-Hsing Chen , Te-Hsiung Wang , Ming-Lung Tsai , Ming-Shyan Lin , Tzu-Hsien Tsai , Tien-Shin Chou , Chin-Ju Tseng , Jhih-Wei Dai , Chien-Wei Cheng , Ning-I Yang , Ming-Jui Hung , Yuan Lin

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Abstract

Aims

Limited evidence exists regarding the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in cardiovascular and renal outcomes in patients with advanced chronic kidney disease (CKD) with an estimated glomerular filtration rate (eGFR) < 30 mL/min per 1.73 m².

Methods

We enrolled patients with type 2 diabetes mellitus and eGFR < 30 mL/min per 1.73 m² who were prescribed SGLT2i or dipeptidyl peptidase 4 inhibitors (DPP4i) from 2016 to 2022 (n = 117,924). The primary cardiovascular outcomes included cardiovascular death, myocardial infarction, ischemic stroke, and heart failure-related admission. Renal outcomes encompassed an eGFR decline of >50 %, a doubling of serum creatinine levels, and progression to dialysis.

Results

The study included 6,730 participants [SGLT2i, n = 1,086; DPP4i, n = 5,644]. In both groups, the composite cardiovascular events developed at a rate of 13.2 events per 100 person-years (PYs) [hazard ratio (HR), 0.92; 95 % confidence interval (CI) 0.71–1.19]. The composite of renal events occurred at a rate of 18.5 and 16.2 events per 100 PYs in the SGLT2i and DPP4i groups, respectively [subdistribution HR 1.12; 95 % CI 0.91–1.38].

Conclusions

Compared to DPP4i, SGLT2i did not show superiority in the reduction of cardiovascular or renal events in CKD stage 4–5 patients.

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慢性肾病4期和5期患者钠-葡萄糖共转运蛋白2抑制剂和二肽基肽酶4抑制剂之间的心血管和肾脏结局：一项基于人群的研究

目的：关于钠-葡萄糖共转运蛋白2抑制剂（SGLT2i）对肾小球滤过率（eGFR）和lt估计的晚期慢性肾病（CKD）患者心血管和肾脏结局的益处的证据有限；30ml /min / 1.73 m2。方法纳入2型糖尿病合并eGFR和lt患者；2016年至2022年（n = 117,924），服用SGLT2i或二肽基肽酶4抑制剂（DPP4i） 30 mL/min / 1.73 m2。主要心血管结局包括心血管死亡、心肌梗死、缺血性卒中和心力衰竭相关入院。肾脏结果包括eGFR下降50%，血清肌酐水平翻倍，进展到透析。结果本研究纳入6730名受试者[SGLT2i， n = 1086；DPP4i, n = 5,644]。在两组中，复合心血管事件的发生率为每100人年（PYs） 13.2次[危险比（HR）， 0.92；95%置信区间（CI） 0.71-1.19]。在SGLT2i组和DPP4i组中，肾脏事件的发生率分别为18.5和16.2 / 100 PYs，[亚分布HR 1.12；95% ci 0.91-1.38]。结论与DPP4i相比，SGLT2i在减少4-5期CKD患者心血管或肾脏事件方面没有表现出优势。

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

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.