Kidney outcomes of SGLT2 inhibitors among older patients with diabetic kidney disease in real-world clinical practice: the Japan Chronic Kidney Disease Database Ex.

IF 3.7 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM BMJ Open Diabetes Research & Care Pub Date : 2024-05-30 DOI:10.1136/bmjdrc-2024-004115
Kaori Kitaoka, Yuichiro Yano, Hajime Nagasu, Hiroshi Kanegae, Noriharu Chishima, Hiroki Akiyama, Kouichi Tamura, Naoki Kashihara
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Abstract

Introduction: We compared the kidney outcomes between patients with diabetic kidney disease (DKD) aged ≥75 years initiating sodium-glucose cotransporter 2 (SGLT2) inhibitors versus other glucose-lowering drugs, additionally presenting with or without proteinuria.

Research design and methods: Using the Japan Chronic Kidney Disease Database, we developed propensity scores, implementing a 1:1 matching protocol. The primary outcome included the decline rate in estimated glomerular filtration rate (eGFR), and secondary outcomes incorporated a composite of a 40% reduction in eGFR or progression to end-stage kidney disease.

Results: At baseline, the mean age at initiation of SGLT2 inhibitors (n=348) or other glucose-lowering medications (n=348) was 77.7 years. The mean eGFR was 59.3 mL/min/1.73m2 and proteinuria was 230 (33.0%) patients. Throughout the follow-up period, the mean annual rate of eGFR change was -0.80 mL/min/1.73 m2/year (95% CI -1.05 to -0.54) among SGLT2 inhibitors group and -1.78 mL/min/1.73 m2/year (95% CI -2.08 to -1.49) in other glucose-lowering drugs group (difference in the rate of eGFR decline between the groups was 0.99 mL/min/1.73 m2/year (95% CI 0.5 to 1.38)), favoring SGLT2 inhibitors (p<0.001). Composite renal outcomes were observed 38 in the SGLT2 inhibitors group and 57 in the other glucose-lowering medications group (HR 0.64, 95% CI 0.42 to 0.97). There was no evidence of an interaction between SGLT2 inhibitors initiation and proteinuria.

Conclusions: The benefits of SGLT2 inhibitors on renal outcomes are also applicable to older patients with DKD aged≥75 years.

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在实际临床实践中,SGLT2 抑制剂对老年糖尿病肾病患者的肾脏疗效:日本慢性肾病数据库试验。
简介我们比较了年龄≥75岁的糖尿病肾病(DKD)患者开始服用钠-葡萄糖共转运体2(SGLT2)抑制剂与其他降糖药物,同时伴有或不伴有蛋白尿时的肾脏预后:利用日本慢性肾脏病数据库,我们制定了倾向评分,并实施了 1:1 匹配方案。主要结果包括估计肾小球滤过率(eGFR)的下降率,次要结果包括eGFR下降40%或进展至终末期肾病的综合结果:基线时,开始服用 SGLT2 抑制剂(348 人)或其他降糖药物(348 人)的平均年龄为 77.7 岁。平均 eGFR 为 59.3 毫升/分钟/1.73 平方米,蛋白尿患者为 230 人(33.0%)。在整个随访期间,SGLT2 抑制剂组患者的 eGFR 平均年变化率为-0.80 mL/min/1.73 m2/年(95% CI -1.05 至-0.54),其他抑制剂组患者的 eGFR 平均年变化率为-1.78 mL/min/1.73 m2/年(95% CI -2.08 至-1.49)。08至-1.49)(组间eGFR下降率差异为0.99 mL/min/1.73 m2/年(95% CI 0.5至1.38)),SGLT2抑制剂更有利(P结论:SGLT2抑制剂对肾脏预后的益处也适用于年龄≥75岁的老年DKD患者。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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