Kidney Week

Abstract: SA-OR085

CKD Progression for Patients with Diabetes and Reduced eGFR Treated with Metformin or Sulfonylurea

Session Information

• Moving the Needle for Treatment of Diabetic Kidney Disease
  November 09, 2019 | Location: Ballroom C, Walter E. Washington Convention Center
  Abstract Time: 05:54 PM - 06:06 PM

Category: Diabetic Kidney Disease

• 602 Diabetic Kidney Disease: Clinical

Authors

• Hung, Adriana, VA Tennessee Valley healthcare System; Vanderbilt University, Nashville, Tennessee, United States

Adriana Hung, MD, MPH

• Griffin, Marie, VA Tennessee Valley healthcare System; Vanderbilt University, Nashville, Tennessee, United States

Marie Griffin,

• Chipman, Jonathan, VA Tennessee Valley healthcare System; Vanderbilt University, Nashville, Tennessee, United States

Jonathan Chipman,

• Hackstadt, Amber J., VA Tennessee Valley healthcare System; Vanderbilt University, Nashville, Tennessee, United States

Amber J. Hackstadt,

• Grijalva, Carlos g., VA Tennessee Valley healthcare System; Vanderbilt University, Nashville, Tennessee, United States

Carlos g. Grijalva,

• Greevy, Robert, Vanderbilt University, Nashville, Tennessee, United States

Robert Greevy,

• Min, Jea young, VA Tennessee Valley healthcare System; Vanderbilt University, Nashville, Tennessee, United States

Jea young Min,

• Roumie, Christianne, VA Tennessee Valley healthcare System; Vanderbilt University, Nashville, Tennessee, United States

Christianne Roumie,

Background

Safety concerns limit metformin use in kidney disease. We compared the incidence of renal events between metformin and sulfonylureas users with reduced estimated glomerular filtration rate (eGFR).

Methods

A retrospective cohort combined Veterans Administration, Medicare, and National Death Index data. Metformin or sulfonylurea users were followed from renal function threshold (eGFR <60 ml/min/1.73m²) until a renal event, treatment change, loss to follow up, death or study end. Renal event was defined as persistent decline in eGFR from baseline of 40% or more (eGFR event) or a diagnosis of end-stage renal disease (ESRD). The analysis compared renal event hazard for metformin vs. sulfonylurea users and estimate cumulative risk in a propensity score matched weighted cohort accounting for the competing risks of non-persistence or death.

Results

There were 74,101 and 28,976 persistent metformin and sulfonylurea users, respectively, who reached renal threshold. The weighted cohort included 24,886 metformin vs. 24,990 sulfonylurea patients; 98% male; 84% white, median (IQR) age 71 years [64, 78]. Median eGFR was 56 ml/min [51.4, 58.0], 10% of the patients had a eGFR <45 ml/min/1.73m² and HbA1c 6.6% [6.1, 7.2]. Metformin users had lower cause-specific hazard of renal events vs. sulfonylurea (adjusted HR 0.81, 95%CI (0.68, 0.98)).

Conclusion

Compared to sulfonylureas, metformin use in patients with reduced eGFR was associated with a lower risk of kidney function decline or ESRD.

Funding

• Veterans Affairs Support