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Kidney Week

Abstract: FR-PO246

Pleiotropic Effects of Oral Anti-Hyperglycemic Drugs on Renal and Cardiovascular Outcomes: A Meta-Analysis

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Susantitaphong, Paweena, Chulalongkorn University, Bangkok, Thailand
  • Chewcharat, Api, Harvard University, Boston, Massachusetts, United States
  • Isaranuwatchai, Suramath, Chulalongkorn University, Bangkok, Thailand
  • Takkavatakarn, Kullaya, Division of Nephrology, King Chulalongkorn Memorial hospital, Bangkok, Thailand
  • Praditpornsilpa, Kearkiat, Chulalongkorn University, Bangkok, Thailand
  • Eiam-Ong, Somchai, Chulalongkorn University, Bangkok, Thailand
Background

Recently, there are a lot of data of novel oral anti-hyperglycemic drugs claiming to slow progression of kidney function decline and decrease cardiovascular events and all-cause mortality. Therefore, we performed the meta-analysis to explore the pleiotropic effects of oral anti-hyperglycemic drugs including sodium-glucose co-transporter-2 (SGLT2) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, and dipeptidyl peptidase-4 (DPP-4) inhibitors on renal and cardiovascular outcomes.

Methods

A systematic literature search was performed in PubMed, Embase and Cochrane Central Register of Controlled Trials to identify randomized controlled trials examining the effects of SGLT2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors on the incidence of new albuminuria, regression of albuminuria, doubling increase in serum creatinine, renal composite outcomes, renal replacement therapy (RRT), renal death, cardiovascular events and all-cause mortality. We used random effect model to compute the pooled adjusted hazard ratios (HR) for interested outcomes.

Results

Fourteen studies with 95,717 participants were included. SGLT2 inhibitors, GLP1 receptor agonists, and DPP4 inhibitors provided significantly lower HR of new incidence of albuminuria. SGLT2 inhibitors and DPP4 inhibitors had significantly higher HR of regression of albuminuria. In terms of renal composite for increasing in serum creatinine more than 40%, RRT, and renal death, there were significantly lower HR by SGLT-2 inhibitors and GLP-1 receptor agonists. In addition, significantly lower HR of doubling in serum creatinine was noted in SGLT-2 inhibitors. Regarding RRT events, HR was lower in SGLT-2 inhibitors. All-cause mortality was significantly reduced by SGLT-2 inhibitors. Finally, SGLT2 inhibitors had significantly lower HR of heart failure events.

Conclusion

SGLT-2 inhibitors exhibited nephroprotective effects in terms of regressing albuminuria, preventing the incidence of new albuminuria, doubling in serum creatinine, RRT events, renal composite outcome, heart failure events, and all-cause mortality. GLP-1 receptor agonists could attenuate the incidence of new albuminuria and renal composite outcomes, while DPP-4 inhibitors could only prevent the incidence of new albuminuria and regress albuminuria.