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IF 3.2 Q1 UROLOGY & NEPHROLOGY

Kidney Medicine Pub Date : 2024-12-30 DOI:10.1016/j.xkme.2024.100963

Liang Feng , Zhong Hong Liew , Yong Mong Bee , Tazeen H. Jafar

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引用次数: 0

摘要

基本原理及目的钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂评估亚洲2型糖尿病患者肾脏结局的临床研究是有限的。我们在临床环境中评估了SGLT2抑制剂与多种族亚洲2型糖尿病患者肾脏和安全性结局的关系。研究设计回顾性队列研究。设置,参与者来自新加坡多机构SingHealth糖尿病注册中心的2型糖尿病患者。2014年至2018年间SGLT2抑制剂的启动者，中位随访时间为25.6个月（四分位数范围为17.9-31.4）。综合肾脏结局（≥40%估计肾小球滤过率[eGFR]下降或替代治疗[KFRT]发生肾衰竭），其组成部分，eGFR变化率，截肢和急性肾损伤（AKI）。分析方法SGLT2抑制剂启动的倾向评分，与其他降糖药的启动物1:1匹配。采用Cox比例风险模型和线性混合效应模型。结果匹配后，有4254例患者新开始使用SGLT-2抑制剂或其他降糖药物（每组2127例）。平均年龄63.4岁（SD 9.2），女性48.6%。总共67.8%的参与者是华人，11.9%是印度人，15.6%是马来人，4.7%是其他民族。启动SGLT2抑制剂与较低的复合肾脏结局风险相关(风险比[HR]， 0.39；95% CI, 0.31-0.48)和eGFR较基线降低≥40% (HR, 0.38；95% ci, 0.31-0.48)。在意向治疗人群中，SGLT2抑制剂的启动也与eGFR下降较慢相关(n = 1,888，斜率差异：2.67 mL/min / 1.73 m2 /年；95% ci, 1.90-3.43)。虽然SGLT2抑制剂与AKI风险降低相关，但未发现与截肢有显著关联。局限性潜在的知情存在偏差、残留和未测量的混杂。结论ssglt2抑制剂可显著改善亚洲多种族2型糖尿病患者的肾脏预后，突出其在预防肾脏并发症方面的作用。关于钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂对亚洲2型糖尿病患者肾脏益处的实际证据有限。本研究考察了SGLT2抑制剂对新加坡不同组2型糖尿病患者肾脏和安全性结局的影响。使用倾向评分，2127例使用SGLT2抑制剂的患者与其他降糖药物使用者的数据进行1:1匹配。在25.6个月的中位随访中，SGLT2抑制剂与其他降糖药物相比，显著肾功能下降的风险降低61%，肾功能丧失的速度减慢。重要的是，它们的使用不会增加截肢或急性肾损伤的风险。这些发现支持了它们在亚洲糖尿病患者肾脏保护中的作用。

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Sodium–Glucose Cotransporter-2 Inhibitors and Prevention of Adverse Kidney Outcomes in Type 2 Diabetes: A Clinical Multiethnic Asian Cohort

Rationale & Objective

Studies of sodium-glucose cotransporter-2 (SGLT2) inhibitors assessing kidney outcomes among Asians with type 2 diabetes in a clinical setting are limited. We assessed the association of SGLT2 inhibitors with kidney and safety outcomes in a diverse multiethnic Asian population with type 2 diabetes in a clinical setting.

Study Design

Retrospective cohort study.

Setting & Participants

Patients with type 2 diabetes from multi-institutional SingHealth Diabetes Registry in Singapore.

Exposure

Initiators of SGLT2 inhibitors between 2014 to 2018 with a median follow-up duration of 25.6 months (interquartile range, 17.9-31.4).

Outcomes

Composite kidney outcome (≥40% estimated glomerular filtration rate [eGFR] decline or incident kidney failure with replacement therapy [KFRT]), its components, rate of eGFR change, amputation, and acute kidney injury (AKI).

Analytical Approach

Propensity scores for SGLT2 inhibitors initiation were developed, with 1:1 matching with initiators of other antidiabetic drugs. Cox proportional hazards and linear mixed effect models were employed.

Results

After matching, there were 4,254 patients newly initiated on either SGLT-2 inhibitors or other glucose-lowering drugs (2,127 in each group). The mean age was 63.4 (SD 9.2) years, with 48.6% women. In total, 67.8% of participants were Chinese, 11.9% Indian, 15.6% Malay, and 4.7% others. Initiating SGLT2 inhibitors was associated with lower risks of composite kidney outcome (hazard ratio [HR], 0.39; 95% CI, 0.31-0.48) and ≥40% reduction in eGFR from baseline (HR, 0.38; 95% CI, 0.31-0.48). SGLT2 inhibitor initiation was also associated with a slower eGFR decline among the intention-to-treat population (n = 1,888, difference in slope: 2.67 mL/min per 1.73 m² per year; 95% CI, 1.90-3.43). No significant association with amputation was found, though SGLT2 inhibitors were associated with reduced AKI risk.

Limitations

Potential informed presence bias and residual and unmeasured confounding.

Conclusions

SGLT2 inhibitors significantly benefit kidney outcomes in multiethnic Asians with type 2 diabetes, highlighting their role in preventing kidney complications.

Plain Language Summary

Real-world evidence on the kidney benefits of sodium-glucose cotransporter-2 (SGLT2) inhibitors among Asians with type 2 diabetes is limited. This study examined the effects of SGLT2 inhibitors on kidney and safety outcomes in a diverse group with type 2 diabetes in Singapore. Data from 2,127 patients initiating SGLT2 inhibitors were matched 1:1 with other glucose-lowering drugs users using propensity scores. Over a median follow-up of 25.6 months, SGLT2 inhibitors were linked to a 61% lower risk of significant kidney function decline and a slower rate of kidney function loss than other glucose-lowering drugs. Importantly, their use did not increase the risk of amputation or acute kidney injury. These findings support their role in kidney protection in Asian populations with diabetes.

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