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Kidney Week

Abstract: PO1012

Renal Outcomes and All-Cause Death Associated with SGLT-2 Inhibitor vs. Other Glucose-Lowering Drugs (CVD-REAL 3 Korea)

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Koh, Eun Sil, The Catholic University of Korea Yeouido Saint Mary's Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
  • Han, Kyungdo, Soongsil University Department of Statistics and Actuarial Science, Dongjak-gu, Seoul, Korea (the Republic of)
  • Lee, Hyewon, AstraZeneca Korea Co Ltd, Seoul, Korea (the Republic of)
  • Nam, You-Seon, AstraZeneca Korea Co Ltd, Seoul, Korea (the Republic of)
  • Wittbrodt, Eric T., AstraZeneca, Gaithersburg, Maryland, United States
  • Fenici, Peter, AstraZeneca, Cambridge, United Kingdom
  • Kosiborod, Mikhail, Saint Luke's Mid America Heart Institute, Kansas City, Missouri, United States
  • L Heerspink, Hiddo Jan, University Medical Center Groningen, Groningen, Netherlands
  • Yoo, Soon-Jib, The Catholic University of Korea Bucheon Saint Mary's Hospital, Bucheon, Gyeonggi-do, Korea (the Republic of)
  • Kwon, Hyuk-Sang, The Catholic University of Korea Yeouido Saint Mary's Hospital, Yeongdeungpo-gu, Seoul, Korea (the Republic of)
Background

Real-world evidence from routine clinical practice elucidating the effects of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on renal outcomes and mortality in patients with type 2 diabetes (T2D) is limited.

Methods

Using data from the Korean National Health Insurance Service database from January 2014 to December 2017, a total of 701,674 patients were identified with T2D. We divided these patients into new-users of SGLT-2i and new-users of other glucose-lowering drugs (oGLD). Using propensity scores, patients in the two groups were matched 1:1. We examined for the risk of end-stage renal disease (ESRD) and all-cause death.

Results

There were 45,016 patients in each group, and baseline characteristics were well-balanced between groups: mean age 58.1 ± 10.6 years; mean estimated glomerular filtration rate (eGFR) 89.2 ± 27.4 ml/min/1.73m2; 8% of patients had proteinuria. We identified 167 incident ESRD and 1,070 all-cause deaths during follow-up. Use of SGLT-2i versus oGLD was associated with a lower risk of ESRD (HR: 0.47; 95% confidence interval [CI]: 0.34 to 0.65) and all-cause death (HR: 0.82; 95% CI: 0.73 to 0.93). In a subgroup analysis by eGFR, initiation of SGLT2i vs oGLD was associated with lower risk of progression to ESRD among patients with eGFR 60-90 and <60 ml/min/1.73m2 and lower risk of all-cause death associated with SGLT-2i versus oGLD was observed across the entire range of renal function.

Conclusion

In this large nationwide study of Korean patients with T2D, initiation of SGLT-2i vs oGLD was associated with lower risk of ESRD and all-cause death.

Funding

  • Commercial Support