| アブストラクト | 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/1.73m(2) 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. |
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| ジャーナル名 | Diabetes, obesity & metabolism |
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| 投稿日 | 2022/6/10 |
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| 投稿者 | Idris, Iskandar; Zhang, Ruiqi; Mamza, Jil B; Ford, Mike; Morris, Tamsin; Banerjee, Amitava; Khunti, Kamlesh |
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| 組織名 | Division of Medical Sciences and Graduate Entry Medicine, School of Medicine,;University of Nottingham, Royal Derby Hospital, Derby, UK.;Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University;of Glasgow, Glasgow, UK.;Medical and Scientific Affairs, BioPharmaceuticals Medical, AstraZeneca, London,;UK.;Institute of Health Informatics, University College London, London, UK.;Department of Cardiology, University College London Hospitals, London, UK.;Diabetes Research Centre, University of Leicester, Leicester, UK. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/35676798/ |
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