Meghana Eswarappa,Erin Madden,Michael G Shlipak,Xiangqin Cui,Michal Mrug,Michelle M Estrella,Meyeon Park
{"title":"钠-葡萄糖共转运蛋白-2抑制剂治疗和常染色体显性多囊肾病退伍军人肾功能的纵向变化","authors":"Meghana Eswarappa,Erin Madden,Michael G Shlipak,Xiangqin Cui,Michal Mrug,Michelle M Estrella,Meyeon Park","doi":"10.2215/cjn.0000000725","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nSodium-glucose cotransporter-2 inhibitors (SGLT2i) are a pillar of kidney disease therapy, but their efficacy remains unknown in Autosomal Dominant Polycystic Kidney Disease (ADPKD). We evaluated effects of SGLT2i on kidney function in ADPKD.\r\n\r\nMETHODS\r\nThis retrospective cohort study within the Veterans Health Administration included adults with an ADPKD diagnosis code who initiated SGLT2i between January 2017 and May 2023. Repeated measures models were used to evaluate eGFR slope before and after SGLT2i initiation. Among patients with ADPKD and type 2 diabetes mellitus (T2DM), a target trial emulation was used to compare the effects of SGLT2i versus dipeptidyl peptidase-4 inhibition (DPP4i) on eGFR slope.\r\n\r\nRESULTS\r\nAmong 348 eligible patients with ADPKD who started an SGLT2i, 93% were male, mean ± standard deviation age was 68 ± 11, and median eGFR was 53 (interquartile range: 16-127) ml/min/1.73m2. In adjusted analyses, the pre-initiation eGFR slope was -0.79 (95% confidence interval: -1.26, -0.33) ml/min/1.73m2 per-90-days. The eGFR slope steepened to -2.78 (-4.04, -1.53) ml/min/1.73m2 during the first three months post-initiation, and then stabilized to -0.07 (-0.72, 0.58) ml/min/1.73m2 during months 3-to-12 post-initiation. The target trial emulation compared 217 SGLT2i-users with 198 DPP4i-users. In adjusted analyses, eGFR declined -4.03 (-6.45, -1.60) mL/min/1.73m2 per-90-days faster in SGLT2i- versus DPP4i-users during the first three months post-initiation; however, during the subsequent 3-to-12 months, the slope was more stable in SGLT2i- than DPP4i-initiators, with a difference of 1.29 (0.16, 2.41) mL/min/1.73m2 per-90-days.\r\n\r\nCONCLUSIONS\r\nIn older patients with mild ADPKD and a high prevalence of diabetes and cardiovascular disease who initiated an SGLT2i, there was an initial three-month decline in eGFR followed by stabilization during the remainder of the year-long follow-up. Compared with DPP4i use, SGLT2i use was associated with a slower eGFR decline between 3-to-12 months post-initiation in patients with concurrent T2DM. These findings suggest that SGLT2is are potentially beneficial in older individuals with ADPKD in whom comorbid disease may play a greater role in kidney function decline, but further studies are required.","PeriodicalId":50681,"journal":{"name":"Clinical Journal of the American Society of Nephrology","volume":"1 1","pages":""},"PeriodicalIF":8.5000,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sodium-Glucose Cotransporter-2 Inhibitor Therapy and Longitudinal Changes in Kidney Function among Veterans with Autosomal Dominant Polycystic Kidney Disease.\",\"authors\":\"Meghana Eswarappa,Erin Madden,Michael G Shlipak,Xiangqin Cui,Michal Mrug,Michelle M Estrella,Meyeon Park\",\"doi\":\"10.2215/cjn.0000000725\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\r\\nSodium-glucose cotransporter-2 inhibitors (SGLT2i) are a pillar of kidney disease therapy, but their efficacy remains unknown in Autosomal Dominant Polycystic Kidney Disease (ADPKD). We evaluated effects of SGLT2i on kidney function in ADPKD.\\r\\n\\r\\nMETHODS\\r\\nThis retrospective cohort study within the Veterans Health Administration included adults with an ADPKD diagnosis code who initiated SGLT2i between January 2017 and May 2023. Repeated measures models were used to evaluate eGFR slope before and after SGLT2i initiation. Among patients with ADPKD and type 2 diabetes mellitus (T2DM), a target trial emulation was used to compare the effects of SGLT2i versus dipeptidyl peptidase-4 inhibition (DPP4i) on eGFR slope.\\r\\n\\r\\nRESULTS\\r\\nAmong 348 eligible patients with ADPKD who started an SGLT2i, 93% were male, mean ± standard deviation age was 68 ± 11, and median eGFR was 53 (interquartile range: 16-127) ml/min/1.73m2. In adjusted analyses, the pre-initiation eGFR slope was -0.79 (95% confidence interval: -1.26, -0.33) ml/min/1.73m2 per-90-days. The eGFR slope steepened to -2.78 (-4.04, -1.53) ml/min/1.73m2 during the first three months post-initiation, and then stabilized to -0.07 (-0.72, 0.58) ml/min/1.73m2 during months 3-to-12 post-initiation. The target trial emulation compared 217 SGLT2i-users with 198 DPP4i-users. In adjusted analyses, eGFR declined -4.03 (-6.45, -1.60) mL/min/1.73m2 per-90-days faster in SGLT2i- versus DPP4i-users during the first three months post-initiation; however, during the subsequent 3-to-12 months, the slope was more stable in SGLT2i- than DPP4i-initiators, with a difference of 1.29 (0.16, 2.41) mL/min/1.73m2 per-90-days.\\r\\n\\r\\nCONCLUSIONS\\r\\nIn older patients with mild ADPKD and a high prevalence of diabetes and cardiovascular disease who initiated an SGLT2i, there was an initial three-month decline in eGFR followed by stabilization during the remainder of the year-long follow-up. Compared with DPP4i use, SGLT2i use was associated with a slower eGFR decline between 3-to-12 months post-initiation in patients with concurrent T2DM. These findings suggest that SGLT2is are potentially beneficial in older individuals with ADPKD in whom comorbid disease may play a greater role in kidney function decline, but further studies are required.\",\"PeriodicalId\":50681,\"journal\":{\"name\":\"Clinical Journal of the American Society of Nephrology\",\"volume\":\"1 1\",\"pages\":\"\"},\"PeriodicalIF\":8.5000,\"publicationDate\":\"2025-05-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical Journal of the American Society of Nephrology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.2215/cjn.0000000725\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"UROLOGY & NEPHROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical Journal of the American Society of Nephrology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.2215/cjn.0000000725","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"UROLOGY & NEPHROLOGY","Score":null,"Total":0}
Sodium-Glucose Cotransporter-2 Inhibitor Therapy and Longitudinal Changes in Kidney Function among Veterans with Autosomal Dominant Polycystic Kidney Disease.
BACKGROUND
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) are a pillar of kidney disease therapy, but their efficacy remains unknown in Autosomal Dominant Polycystic Kidney Disease (ADPKD). We evaluated effects of SGLT2i on kidney function in ADPKD.
METHODS
This retrospective cohort study within the Veterans Health Administration included adults with an ADPKD diagnosis code who initiated SGLT2i between January 2017 and May 2023. Repeated measures models were used to evaluate eGFR slope before and after SGLT2i initiation. Among patients with ADPKD and type 2 diabetes mellitus (T2DM), a target trial emulation was used to compare the effects of SGLT2i versus dipeptidyl peptidase-4 inhibition (DPP4i) on eGFR slope.
RESULTS
Among 348 eligible patients with ADPKD who started an SGLT2i, 93% were male, mean ± standard deviation age was 68 ± 11, and median eGFR was 53 (interquartile range: 16-127) ml/min/1.73m2. In adjusted analyses, the pre-initiation eGFR slope was -0.79 (95% confidence interval: -1.26, -0.33) ml/min/1.73m2 per-90-days. The eGFR slope steepened to -2.78 (-4.04, -1.53) ml/min/1.73m2 during the first three months post-initiation, and then stabilized to -0.07 (-0.72, 0.58) ml/min/1.73m2 during months 3-to-12 post-initiation. The target trial emulation compared 217 SGLT2i-users with 198 DPP4i-users. In adjusted analyses, eGFR declined -4.03 (-6.45, -1.60) mL/min/1.73m2 per-90-days faster in SGLT2i- versus DPP4i-users during the first three months post-initiation; however, during the subsequent 3-to-12 months, the slope was more stable in SGLT2i- than DPP4i-initiators, with a difference of 1.29 (0.16, 2.41) mL/min/1.73m2 per-90-days.
CONCLUSIONS
In older patients with mild ADPKD and a high prevalence of diabetes and cardiovascular disease who initiated an SGLT2i, there was an initial three-month decline in eGFR followed by stabilization during the remainder of the year-long follow-up. Compared with DPP4i use, SGLT2i use was associated with a slower eGFR decline between 3-to-12 months post-initiation in patients with concurrent T2DM. These findings suggest that SGLT2is are potentially beneficial in older individuals with ADPKD in whom comorbid disease may play a greater role in kidney function decline, but further studies are required.
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.