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Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis

BACKGROUND: Kidney benefits have been demonstrated for both sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) compared with placebo in patients with type 2 diabetes. This study aimed to compare the impacts of SGLT2i and GLP1RA on the trend of e...

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Autores principales: Lui, David Tak Wai, Au, Ivan Chi Ho, Tang, Eric Ho Man, Cheung, Ching Lung, Lee, Chi Ho, Woo, Yu Cho, Wu, Tingting, Tan, Kathryn Choon Beng, Wong, Carlos King Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241106/
https://www.ncbi.nlm.nih.gov/pubmed/35784442
http://dx.doi.org/10.1016/j.eclinm.2022.101510
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author Lui, David Tak Wai
Au, Ivan Chi Ho
Tang, Eric Ho Man
Cheung, Ching Lung
Lee, Chi Ho
Woo, Yu Cho
Wu, Tingting
Tan, Kathryn Choon Beng
Wong, Carlos King Ho
author_facet Lui, David Tak Wai
Au, Ivan Chi Ho
Tang, Eric Ho Man
Cheung, Ching Lung
Lee, Chi Ho
Woo, Yu Cho
Wu, Tingting
Tan, Kathryn Choon Beng
Wong, Carlos King Ho
author_sort Lui, David Tak Wai
collection PubMed
description BACKGROUND: Kidney benefits have been demonstrated for both sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) compared with placebo in patients with type 2 diabetes. This study aimed to compare the impacts of SGLT2i and GLP1RA on the trend of estimated glomerular filtration rate (eGFR) and other kidney outcomes. METHODS: Using a real-world population-based database, the Hong Kong Hospital Authority (HA) database, of patients with type 2 diabetes between January 2008 and December 2020, patients started on SGLT2i were compared with those started on GLP1RA, with one-to-one propensity-score matching. Primary outcome was a composite of sustained ≥50% eGFR decline, end-stage kidney disease (ESKD), incident macroalbuminuria and kidney-related mortality. Secondary outcome was the rate of eGFR decline. FINDINGS: A total of 2551 SGLT2i and 2551 GLP1RA new users were analyzed. At baseline, mean age was 56·2 years, with mean eGFR 78·0 mL/min/1·73m(2) and 11·9% having macroalbuminuria. Upon median follow-up of 13 months (IQR: 5-27), SGLT2i users had a lower risk of composite kidney outcomes (HR=0·77, 95%CI 0·62–0·96, p = 0·02), mainly driven by a reduction in ESKD (HR=0·53, p = 0·01). SGLT2i users also tended to have a lower risk of incident macroalbuminuria (HR=0·74, p = 0·05). Subgroup analyses of the benefits of SGLT2i use on composite kidney outcomes did not reveal interaction by age, sex, baseline eGFR/albuminuria status, hemoglobin A1c (HbA1c) and renin-angiotensin-system inhibitor use. Furthermore, SGLT2i users had a slower eGFR decline than GLP1RA users (SGLT2i: -1·19 mL/min/1·73m(2)/year, GLP1RA: -1·95 mL/min/1·73m(2)/year, p < 0·01). INTERPRETATION: Our results suggest that SGLT2i might be superior to GLP1RA in reducing kidney outcomes among patients with type 2 diabetes. Future trials are needed to corroborate our findings. FUNDING: None.
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spelling pubmed-92411062022-06-30 Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis Lui, David Tak Wai Au, Ivan Chi Ho Tang, Eric Ho Man Cheung, Ching Lung Lee, Chi Ho Woo, Yu Cho Wu, Tingting Tan, Kathryn Choon Beng Wong, Carlos King Ho eClinicalMedicine Articles BACKGROUND: Kidney benefits have been demonstrated for both sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) compared with placebo in patients with type 2 diabetes. This study aimed to compare the impacts of SGLT2i and GLP1RA on the trend of estimated glomerular filtration rate (eGFR) and other kidney outcomes. METHODS: Using a real-world population-based database, the Hong Kong Hospital Authority (HA) database, of patients with type 2 diabetes between January 2008 and December 2020, patients started on SGLT2i were compared with those started on GLP1RA, with one-to-one propensity-score matching. Primary outcome was a composite of sustained ≥50% eGFR decline, end-stage kidney disease (ESKD), incident macroalbuminuria and kidney-related mortality. Secondary outcome was the rate of eGFR decline. FINDINGS: A total of 2551 SGLT2i and 2551 GLP1RA new users were analyzed. At baseline, mean age was 56·2 years, with mean eGFR 78·0 mL/min/1·73m(2) and 11·9% having macroalbuminuria. Upon median follow-up of 13 months (IQR: 5-27), SGLT2i users had a lower risk of composite kidney outcomes (HR=0·77, 95%CI 0·62–0·96, p = 0·02), mainly driven by a reduction in ESKD (HR=0·53, p = 0·01). SGLT2i users also tended to have a lower risk of incident macroalbuminuria (HR=0·74, p = 0·05). Subgroup analyses of the benefits of SGLT2i use on composite kidney outcomes did not reveal interaction by age, sex, baseline eGFR/albuminuria status, hemoglobin A1c (HbA1c) and renin-angiotensin-system inhibitor use. Furthermore, SGLT2i users had a slower eGFR decline than GLP1RA users (SGLT2i: -1·19 mL/min/1·73m(2)/year, GLP1RA: -1·95 mL/min/1·73m(2)/year, p < 0·01). INTERPRETATION: Our results suggest that SGLT2i might be superior to GLP1RA in reducing kidney outcomes among patients with type 2 diabetes. Future trials are needed to corroborate our findings. FUNDING: None. Elsevier 2022-06-25 /pmc/articles/PMC9241106/ /pubmed/35784442 http://dx.doi.org/10.1016/j.eclinm.2022.101510 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Articles
Lui, David Tak Wai
Au, Ivan Chi Ho
Tang, Eric Ho Man
Cheung, Ching Lung
Lee, Chi Ho
Woo, Yu Cho
Wu, Tingting
Tan, Kathryn Choon Beng
Wong, Carlos King Ho
Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis
title Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis
title_full Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis
title_fullStr Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis
title_full_unstemmed Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis
title_short Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis
title_sort kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: a real-world population-based analysis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9241106/
https://www.ncbi.nlm.nih.gov/pubmed/35784442
http://dx.doi.org/10.1016/j.eclinm.2022.101510
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