medwireNews: Long-term use of sodium-glucose cotransporter (SGLT)2 inhibitors in patients with type 2 diabetes and stage 5 chronic kidney disease (CKD) reduces the risk for dialysis and hospitalization for heart failure and acute myocardial infarction (MI) compared with no use, suggests a study published in the Annals of Internal Medicine.
“Extended to the most up-to-date consensuses on SGLT2 [inhibitor] use for those with eGFR [estimated glomerular filtration rate] 20 mL/min/1.73m2 or greater, our results further indicate that SGLT2 [inhibitor] use may be beneficial for patients even with eGFR less than 15 mL/min/1.73 m2,” say the researchers. However, they note that SGLT2 inhibitor use did not reduce the risk for all-cause mortality in patients with type 2 diabetes and stage 5 CKD.
For the Taiwanese study, which followed a sequential target trial emulation principle, Chih-Cheng Hsu (National Health Research Institutes, Zhunan) and colleagues used National Health Insurance government data to identify patients aged between 20 and 100 years with type 2 diabetes and stage 5 CKD, defined as an eGFR of less than 15 mL/min per 1.73 m2, who received or did not receive an SGLT2 inhibitor prescription for type 2 diabetes between May 2016 and October 2021.
The investigators selected 23,854 patients who received an SGLT2 inhibitor prescription and 23,892 who did not. The mean age of the study participants was 61 years; most were aged 40–64 years. Men accounted for 50.2% of the participants. The mean duration of diabetes was 5.3 years, mean glycated hemoglobin was 8.2% (66.1 mmol/mol), and the mean urine albumin to creatinine ratio was 82 mg/g.
Over the mean follow-up of 3.1 years, SGLT2 inhibitor use was associated with a “substantially lower” risk for dialysis and hospitalization for acute MI or heart failure than no use, say the researchers.
In the intention-to treat model, patients taking SGLT2 inhibitors were a significant 66% less likely than those not taking SGLT2 inhibitors to need long-term dialysis, after taking into account an array of covariates, such as age, sex, comorbidities, duration of diabetes, and medication use, with incidence rates per 1000 person–years of 1.69 versus 4.76.
They were also a significant 39% less likely to be admitted to hospital for acute MI and 20% less likely to be admitted for heart failure, with incidence rates per 1000 person–years of 21.07 versus 21.14 and 4.02 versus 5.16, compared with individuals who did not take SGLT2 inhibitors.
Occurrence of the safety outcomes of diabetic ketoacidosis (DKA) and acute kidney injury (AKI) was also significantly lower in the group prescribed SGLT2 inhibitors than the control group. The incidence rates for DKA hospital admission were 18.55 versus 20.37 per 1000 person–years with a hazard ratio (HR) of 0.78, and for AKI hospital admission, they were 8.4 versus 10.11 per 1000 person–years, with an HR of 0.80.
The difference in all-cause mortality between the two treatment groups was not significantly different, however, with incidence rates of 12.68 vs 10.55 per 1000 person–years.
The researchers conclude that SGLT2 inhibitors are likely to be “a cornerstone in managing patients at different stages of CKD to reduce the risk for dialysis and cardiovascular disease.”
However, they acknowledge that their findings might not apply to CKD patients without type 2 diabetes, and that randomized trials including patients of other ethnicities are needed for confirmation.
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