Kidney outcomes in patients with diabetes mellitus did not differ between individual sodium-glucose cotransporter-2 inhibitors
Kidney outcomes in patients with diabetes mellitus did not differ between individual sodium-glucose cotransporter-2 inhibitors
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糖尿病患者的肾脏结局在不同的钠-葡萄糖协同转运蛋白 2 抑制剂之间没有差异
DOI：
10.1016/j.kint.2022.05.031
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发表时间：
2022
影响因子：
19.6
通讯作者：
Komuro Issei
中科院分区：
文献类型：
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作者：
Suzuki Yuta;Kaneko Hidehiro;Okada Akira;Matsuoka Satoshi;Fujiu Katsuhito;Michihata Nobuaki;Jo Taisuke;Takeda Norifumi;Morita Hiroyuki;Node Koichi;Nangaku Masaomi;Yasunaga Hideo;Komuro Issei
比较单独的钠-葡萄糖共转运体-2(SGLT2)抑制剂的肾脏结果的数据有限。在这里，我们的目的是比较不同抑制剂之间随后发生肾脏结果的风险。这将是第一次使用大规模真实数据集比较新接受单独SGLT2抑制剂治疗的糖尿病患者的肾脏结果的研究。为此，我们分析了12,100名服用不同SGLT2抑制剂的糖尿病患者的结果(2,573名服用埃帕利福秦；2,214名服用达帕利福秦；2,100名服用卡那格列齐；以及5,213名服用其他此类抑制剂)。主要结果是估计肾小球滤过率(EGFR)的下降率，这是使用具有非结构协方差的线性混合效应模型评估的。患者的中位年龄为53岁，其中84.4%为男性。空腹血糖和糖化血红蛋白的中位数分别为147(四分位数范围126-178)mg/dL和7.5(6.9-8.4)%。EGFR中位数为78mL/min/1.73m2(四分位数范围68~90)。平均随访期为773天。倍他格列芬、达格列夫秦、卡那格列夫秦和其他SGLT2抑制剂的年EGFR斜率分别为-1.15(95%可信区间，-1.33~-0.96)、-1.14(-1.32~-0.96)、-1.24(-1.44~-1.04)和-1.06(-1.18~-0.94)ml/min/1.73m2。使用线性混合效应模型，未检测到SGLT2抑制剂与时间之间的显著交互作用。大量的敏感性分析证实了我们初步结果的稳健性。因此，我们发现服用不同SGLT2抑制剂的患者之间的EGFR年下降斜率没有显著差异。
Data comparing kidney outcomes between individual sodium-glucose cotransporter-2 (SGLT2) inhibitors are limited. Here, we aimed to compare the subsequent risk of developing kidney outcomes between individual inhibitors. This would be the first study to compare kidney outcomes of patients with diabetes mellitus who were newly treated with individual SGLT2 inhibitors using a large-scale real-world dataset. To do this, we analyzed results from 12,100 patients with diabetes mellitus who were taking different SGLT2 inhibitors (2,573 with empagliflozin; 2,214 with dapagliflozin; 2,100 with canagliflozin; and 5,213 with other such inhibitors). The primary outcome was the rate of estimated glomerular filtration rate (eGFR) decline as assessed using a linear mixed-effects model with an unstructured covariance. The median age of the patients was 53 years, and 84.4% of the patients were men. The median fasting plasma glucose and HbA1c levels were 147 (interquartile range 126–178) mg/dL and 7.5 (6.9–8.4)%, respectively. The median eGFR was 78 mL/min/1.73 m2(interquartile range 68–90). The mean follow-up period was 773 days. The annual eGFR slopes of empagliflozin, dapagliflozin, canagliflozin, and other SGLT2 inhibitors were -1.15 (95% confidence interval, -1.33 to -0.96), -1.14 (-1.32 to -0.96), -1.24 (-1.44 to -1.04), and -1.06 (-1.18 to -0.94) ml/min/1.73 m2, respectively. No significant interaction was detected between the SGLT2 inhibitors and time using a linear mixed-effects model. A multitude of sensitivity analyses confirmed the robustness of our primary results. Thus, we found that there was no significant difference in the annual eGFR decline slopes between patients taking different SGLT2 inhibitors.