| アブストラクト | INTRODUCTION: To assess the comparative effectiveness and safety of renal-related outcomes associated with sodium-glucose cotransporter-2 inhibitors (SGLT2-i) initiation among patients with type 2 diabetes using real-world data. RESEARCH DESIGN AND METHODS: We conducted a population-based cohort study using administrative healthcare data from Alberta (AB), Canada and primary care data from the Clinical Practice Research Datalink (CPRD), UK. From a cohort of new metformin users, we identified initiators of a SGLT2-i or dipeptidyl peptidase-4 inhibitor (DPP4-i) between January 1, 2014 and March 30, 2018 (AB) or between January 1, 2013 and November 29, 2018 (CPRD). Initiators of an SGLT2-i or DPP4-i were followed until death, disenrolment, therapy discontinuation, or study end date. The effectiveness outcome was renal disease progression, defined as a composite of new-onset macroalbuminuria, serum creatinine doubling with estimated glomerular filtration rate of </=45 mL/min/1.73 m(2), renal replacement therapy, hospital admission or death from renal causes. The safety outcome was hospitalization due to acute kidney injury (AKI). We adjusted for confounding using high-dimensional propensity score matching and estimated HRs using Cox proportional hazards regression. Aggregate data from each database were combined by random-effects meta-analysis. RESULTS: Among the 29 465 included patients (20 564 AB, 8901 CPRD), 37.5% were new SGLT2-i users in AB and 21.3% in CPRD. Compared with DPP4 initiators, SGLT2-i initiators were associated with a reduced risk of renal disease progression (pooled HR 0.79, 95% CI 0.62 to 1.00); however, there was no significant difference in the risk of AKI (pooled HR 0.89, 95% CI 0.58 to 1.36). These findings were consistent with other exposure definitions and antidiabetic comparators. CONCLUSIONS: Our findings support a renoprotective effect of SGLT2-i without an increased risk of AKI, compared with clinically relevant active comparators. |
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| ジャーナル名 | BMJ open diabetes research & care |
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| 投稿日 | 2021/12/16 |
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| 投稿者 | Alkabbani, Wajd; Zongo, Arsene; Minhas-Sandhu, Jasjeet K; Eurich, Dean T; Shah, Baiju R; Alsabbagh, Mhd Wasem; Gamble, John-Michael |
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| 組織名 | School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada.;Faculte de pharmacie, Universite Laval, Laval, Quebec, Canada.;CHU de Quebec-Universite Laval Research Center, Quebec City, Quebec, Canada.;School of Public Health, University of Alberta, Edmonton, Alberta, Canada.;Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario,;Canada.;School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada;jm.gamble@uwaterloo.ca. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/34906925/ |
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