Kidney Week

Abstract: TH-OR035

Treatment with Dipeptidyl-Peptidase Inhibitors (DPP4_Rx) Delays Progression of Kidney Disease and Reduces Mortality

Session Information

• Diabetic Kidney Disease Trials: Progress Being Made
  October 25, 2018 | Location: 5A, San Diego Convention Center
  Abstract Time: 05:18 PM - 05:30 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Garcia-Touza, Mariana, Kansas City VA Medical Center, Kansas City, Missouri, United States

Mariana Garcia-Touza, MD

• Wiegmann, Thomas, Kansas City VA Medical Center, Kansas City, Missouri, United States

Thomas Wiegmann,

• Oni, Olurinde, Kansas City VA Medical Center, Kansas City, Missouri, United States

Olurinde Oni,

• Wiegmann, Peter Sigurd, Midwest Biomedical Research Foundation, Kansas City, Missouri, United States

Peter Sigurd Wiegmann,

• Goel, Archana, Kansas City VA Medical Center, Kansas City, Missouri, United States

Archana Goel,

• Sharma, Mukut, Kansas City VA Medical Center, Kansas City, Missouri, United States

Mukut Sharma,

• Sharma, Ram, Kansas City VA Medical Center, Kansas City, Missouri, United States

Ram Sharma,

• Gomes, Maria N., Kansas City VA Medical Center, Kansas City, Missouri, United States

Maria N. Gomes,

• Savin, Virginia J., Kansas City VA Medical Center, Kansas City, Missouri, United States

Virginia J. Savin,

Group or Team Name

• Cardiovascular and Renal Clinical Research at MidWest BioMedical Research Foundation

Background

Effects of DPP4_Rx on cardiovascular morbidity are disputed and effects on renal function are not known.

Methods

Data from a large cohort of veterans diagnosed with type 2 diabetes mellitus (T2DM) were used to identify patients on DPP4_Rx (group 1). and without DPP4_Rx (group 2). Groups were matched for age (yrs), sex, BMI, initial renal function, follow-up time (FU, minimum 365 days). Propensity score matching (PSM) was used to adjust groups 1 and 2 with a best odds ratio about 1:2. Groups were compared to determine the effect of DPP4_Rx on the progression of CKD and all-cause mortality. Increase in serum creatinine (creat, mg/dl) over time (days) was taken as a measure of progression of CKD. Data were extracted using the Veterans Administration Informatics and Computing Infrastructure (VINCI), and analyzed using SPSS and SAS. Results were compared using t-tests, frequency tables, Kaplan Meier survival curves, hazard ratios (HR) and p values.

Results

Results show that subjects in group 1 (N=20,424) had baseline variables (creat 1.061, FU 1117, age 68.2 yrs and BMI 31.9) similar to Group 2 (N=52,118, creat 1.09, FU 1197, age 69.9, BMI 31.7). DM control improved in group 1 (HgbA1c 8.3% to 7.9%, p < 0.001) but remained worse than group 2 (7.2% to 7.1%) A significant reduction in progression of CKD was seen in group 1. The proportion of patients exceeding creat of 1.5, 3, and 6 mg/dl was reduced by 6.5, 40.8 and 47.4%, all p<0.01 respectively. Time to ESRD (creat >6.0 mg/dl) was delayed also by 143.7 days p < 0.01. Mortality from all causes was reduced by 78.1%, but time to death was not changed.

Conclusion

We conclude that DPP4_Rx associates with a significant reduction in frequency of all-cause mortality and progression toward ESRD independent of glucose control. The data are consistent with a reduction in the number and severity of discrete morbid events that would associate with progressive renal disease and all cause mortality..

Funding

• Veterans Affairs Support