Significant reduction in chronic kidney disease progression with sodium glucose co‐transporter‐2 inhibitors compared to dipeptidyl peptidase‐4 inhibitors in adults with type 2 diabetes in UK clinical setting: an observational outcomes study based on international guidelines for kidney disease

Idris, I., Zhang, R. , Mamza, J. B., Ford, M., Morris, T., Banerjee, A. and Khunti, K. (2022) Significant reduction in chronic kidney disease progression with sodium glucose co‐transporter‐2 inhibitors compared to dipeptidyl peptidase‐4 inhibitors in adults with type 2 diabetes in UK clinical setting: an observational outcomes study based on international guidelines for kidney disease. Diabetes, Obesity and Metabolism, 24(11), pp. 2138-2147. (doi: 10.1111/dom.14799) (PMID:35676798)

Abstract

Aims: To confirm the reno-protective effects of sodium-glucose cotransporter-2 (SGLT2) inhibitors compared with dipeptidyl peptidase-4 (DPP-4) inhibitors on the onset and progression of chronic kidney disease (CKD) in routine clinical practice. Materials and Methods: We conducted a retrospective cohort study using the Clinical Practice Research Datalink Aurum database linked to Hospital Episode Statistics. The primary outcome was risk of the composite CKD endpoint based on the recent consensus guidelines for kidney disease: >40% decline in estimated glomerular filtration rate (eGFR), kidney death or end-stage kidney disease (ESKD; a composite of kidney transplantation, maintenance of dialysis, sustained low eGFR <15 ml/min/1.73m² or diagnosis of ESKD). Secondary outcomes were components of the composite CKD endpoint, analysed separately. Patients were propensity-score-matched 1:1 for SGLT2 inhibitor versus DPP-4 inhibitor use. Results: A total of 131 824 people with type 2 diabetes (T2D) were identified; 79.0% had no known history of CKD. During a median follow-up of 2.1 years, SGLT2 inhibitor initiation was associated with lower risk of progression to composite kidney endpoints than DPP-4 inhibitor initiation (7.48 vs. 11.77 events per 1000 patient-years, respectively). Compared with DPP-4 inhibitor initiation, SGLT2 inhibitor initiation was associated with reductions in the primary composite CKD endpoint (hazard ratio [HR] 0.64, 95% confidence interval [CI] 0.56-0.74), all-cause mortality (HR 0.74, 95% CI 0.64-0.86) and ESKD (HR 0.37, 95% CI 0.25-0.55), reduced the rate of sustained low eGFR (HR 0.33, 95% CI 0.19-0.57), and reduced diagnoses of ESKD in primary care (HR 0.04, 95% CI 0.01-0.18). Results were consistent across subgroup and sensitivity analyses. Conclusions: In adults with T2D, initiation of an SGLT2 inhibitor was associated with a significantly reduced risk of CKD progression and death compared with initiation of a DPP-4 inhibitor.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Zhang, Miss Rui Qi
• Authors: Idris, I., Zhang, R., Mamza, J. B., Ford, M., Morris, T., Banerjee, A., and Khunti, K.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Diabetes, Obesity and Metabolism
• Publisher: Wiley
• ISSN: 1462-8902
• ISSN (Online): 1463-1326
• Published Online: 08 June 2022
• Copyright Holders: Copyright © 2022 The Authors
• First Published: First published in Diabetes, Obesity and Metabolism 24(11): 2138-2147
• Publisher Policy: Reproduced under a Creative Commons License