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Article: 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 |
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Authors | |
Issue Date | 2022 |
Publisher | Elsevier Ltd. The Journal's web site is located at https://www.journals.elsevier.com/eclinicalmedicine |
Citation | eClinicalMedicine, 2022, v. 50 How to Cite? |
Abstract | 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/1·73m2 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/1·73m2/year, GLP1RA: -1·95 mL/min/1·73m2/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. |
Persistent Identifier | http://hdl.handle.net/10722/313804 |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | Lui, TWD | - |
dc.contributor.author | AU, CH | - |
dc.contributor.author | TANG, HM | - |
dc.contributor.author | Cheung, CL | - |
dc.contributor.author | Lee, CHP | - |
dc.contributor.author | Woo, YC | - |
dc.contributor.author | WU, T | - |
dc.contributor.author | Tan, KCB | - |
dc.contributor.author | Wong, CKH | - |
dc.date.accessioned | 2022-07-05T05:06:02Z | - |
dc.date.available | 2022-07-05T05:06:02Z | - |
dc.date.issued | 2022 | - |
dc.identifier.citation | eClinicalMedicine, 2022, v. 50 | - |
dc.identifier.uri | http://hdl.handle.net/10722/313804 | - |
dc.description.abstract | 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/1·73m2 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/1·73m2/year, GLP1RA: -1·95 mL/min/1·73m2/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. | - |
dc.language | eng | - |
dc.publisher | Elsevier Ltd. The Journal's web site is located at https://www.journals.elsevier.com/eclinicalmedicine | - |
dc.relation.ispartof | eClinicalMedicine | - |
dc.title | Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis | - |
dc.type | Article | - |
dc.identifier.email | Lui, TWD: dtwlui@hku.hk | - |
dc.identifier.email | Cheung, CL: lung1212@hku.hk | - |
dc.identifier.email | Lee, CHP: pchlee@hku.hk | - |
dc.identifier.email | Woo, YC: wooyucho@hku.hk | - |
dc.identifier.email | Tan, KCB: kcbtan@hkucc.hku.hk | - |
dc.identifier.email | Wong, CKH: carlosho@hku.hk | - |
dc.identifier.authority | Lui, TWD=rp02803 | - |
dc.identifier.authority | Cheung, CL=rp01749 | - |
dc.identifier.authority | Lee, CHP=rp02043 | - |
dc.identifier.authority | Tan, KCB=rp00402 | - |
dc.identifier.authority | Wong, CKH=rp01931 | - |
dc.identifier.doi | 10.1016/j.eclinm.2022.101510 | - |
dc.identifier.hkuros | 333946 | - |
dc.identifier.volume | 50 | - |
dc.identifier.isi | WOS:000831566900008 | - |