2型糖尿病患者肾脏疾病进展的风险评估和SGLT2抑制的疗效。

IF 14.8 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Diabetes Care Pub Date : 2023-10-01 DOI:10.2337/dc23-0492
Filipe A Moura, David D Berg, Andrea Bellavia, Jamie P Dwyer, Ofri Mosenzon, Benjamin M Scirica, Stephen D Wiviott, Deepak L Bhatt, Itamar Raz, Mark W Feinberg, Eugene Braunwald, David A Morrow, Marc S Sabatine
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引用次数: 1

摘要

目的:开发一种风险评估工具,以确定肾病进展风险较高的2型糖尿病(T2D)患者,以及可能从钠-葡萄糖协同转运蛋白2(SGLT2)抑制中获益更多的患者。研究设计和方法:来自四项心肌梗死溶栓(TIMI)临床试验的41204名T2D患者被分为衍生组(70%)和验证组(30%)。通过多变量Cox回归选择肾脏疾病进展的候选预测因素(估计肾小球滤过率[eGFR]持续下降≥40%、终末期肾脏疾病或肾脏死亡的复合因素)。达格列嗪的疗效按风险类别进行评估(低:结果:在中位2.4年的随访中,共有695例事件。最终模型包括8个肾脏疾病进展的独立预测因素:动脉粥样硬化性心血管疾病、心力衰竭、收缩压、T2D持续时间、糖化血红蛋白、eGFR、尿白蛋白与肌酸酐比率和血红蛋白。c指数分别为0.798(95%CI,0.774-0.821)和0.798(95%可信区间,0.765-0.831)。验证队列中的校准图斜率(预测风险与观察风险的十分位数)为0.98(95%CI,0.93-1.04)。尽管达格列嗪的相对风险降低在不同风险类别中没有差异,但基线风险较高的患者的绝对风险降低更大,最高风险组在4年时肾脏疾病进展的绝对风险减少3.5%(≥1%/年)。结果与2022年慢性肾脏疾病预后联盟风险预测模型相似。结论:肾脏疾病进展的风险模型可以应用于T2D患者,以对风险进行分层,并确定那些从SGLT2抑制中获益更大的患者。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Risk Assessment of Kidney Disease Progression and Efficacy of SGLT2 Inhibition in Patients With Type 2 Diabetes.

Risk Assessment of Kidney Disease Progression and Efficacy of SGLT2 Inhibition in Patients With Type 2 Diabetes.

Risk Assessment of Kidney Disease Progression and Efficacy of SGLT2 Inhibition in Patients With Type 2 Diabetes.

Risk Assessment of Kidney Disease Progression and Efficacy of SGLT2 Inhibition in Patients With Type 2 Diabetes.

Objective: To develop a risk assessment tool to identify patients with type 2 diabetes (T2D) at higher risk for kidney disease progression and who might benefit more from sodium-glucose cotransporter 2 (SGLT2) inhibition.

Research design and methods: A total of 41,204 patients with T2D from four Thrombolysis In Myocardial Infarction (TIMI) clinical trials were divided into derivation (70%) and validation cohorts (30%). Candidate predictors of kidney disease progression (composite of sustained ≥40% decline in estimated glomerular filtration rate [eGFR], end-stage kidney disease, or kidney death) were selected with multivariable Cox regression. Efficacy of dapagliflozin was assessed by risk categories (low: <0.5%; intermediate: 0.5 to <2%; high: ≥2%) in Dapagliflozin Effect on Cardiovascular Events (DECLARE)-TIMI 58.

Results: There were 695 events over a median follow-up of 2.4 years. The final model comprised eight independent predictors of kidney disease progression: atherosclerotic cardiovascular disease, heart failure, systolic blood pressure, T2D duration, glycated hemoglobin, eGFR, urine albumin-to-creatinine ratio, and hemoglobin. The c-indices were 0.798 (95% CI, 0.774-0.821) and 0.798 (95% CI, 0.765-0.831) in the derivation and validation cohort, respectively. The calibration plot slope (deciles of predicted vs. observed risk) was 0.98 (95% CI, 0.93-1.04) in the validation cohort. Whereas relative risk reductions with dapagliflozin did not differ across risk categories, there was greater absolute risk reduction in patients with higher baseline risk, with a 3.5% absolute risk reduction in kidney disease progression at 4 years in the highest risk group (≥1%/year). Results were similar with the 2022 Chronic Kidney Disease Prognosis Consortium risk prediction model.

Conclusions: Risk models for kidney disease progression can be applied in patients with T2D to stratify risk and identify those who experience a greater magnitude of benefit from SGLT2 inhibition.

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来源期刊
Diabetes Care
Diabetes Care 医学-内分泌学与代谢
CiteScore
27.80
自引率
4.90%
发文量
449
审稿时长
1 months
期刊介绍: The journal's overarching mission can be captured by the simple word "Care," reflecting its commitment to enhancing patient well-being. Diabetes Care aims to support better patient care by addressing the comprehensive needs of healthcare professionals dedicated to managing diabetes. Diabetes Care serves as a valuable resource for healthcare practitioners, aiming to advance knowledge, foster research, and improve diabetes management. The journal publishes original research across various categories, including Clinical Care, Education, Nutrition, Psychosocial Research, Epidemiology, Health Services Research, Emerging Treatments and Technologies, Pathophysiology, Complications, and Cardiovascular and Metabolic Risk. Additionally, Diabetes Care features ADA statements, consensus reports, review articles, letters to the editor, and health/medical news, appealing to a diverse audience of physicians, researchers, psychologists, educators, and other healthcare professionals.
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