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Kidney Week

Abstract: PO1014

Comparative Effectiveness of SGLT2 Inhibitors vs. Other Antihyperglycemics on Risk of Kidney Outcomes: A Cohort Study

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Xie, Yan, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • Bowe, Benjamin Charles, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • Gibson, Andrew K., Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • McGill, Janet B., Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States
  • Yan, Yan, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
  • Maddukuri, Geetha S., Nephrology Section, Medicine Service, VA Saint Louis Health Care System, St. Louis, Missouri, United States
  • Al-Aly, Ziyad, Clinical Epidemiology Center, VA Saint Louis healthcare system, St. Louis, Missouri, United States
Background

In randomized controlled trials, sodium-glucose co-transporter-2 inhibitor (SGLT2i) reduced the risk of adverse kidney outcomes. We aimed to examine the comparative effectiveness of SGLT2i and other antihyperglycemics on the risk of major adverse kidney events (MAKE) of estimated glomerular filtration rate (eGFR) decline >50%, end-stage kidney disease, or all-cause mortality.

Methods

We built a cohort of 379,191 new users of SGLT2i or other antihyperglycemics. Risk of MAKE during follow up served as the primary outcome. Pre-defined covariates and covariates identified by a high-dimensional variable selection algorithm were used to build a propensity score. Linear mixed models were used to estimate the longitudinal change of eGFR and body mass index (BMI) and survival analyses were used to estimate the risk difference of MAKE.

Results

Compared to other antihyperglycemics, SGLT2i use was associated with 0.98 (0.48, 1.53) ml/min/1.73m2 less annual reduction in eGFR, 0.24 (0.17, 0.32) kg/m2 more annual decrease in BMI, and reduced risk of MAKE (HR=0.68 (0.64-0.73)). SGLT2i use was associated with reduced risk of MAKE in eGFR≥90, ≥60 to <90, ≥45 to <60, and ≥30 to <45 ml/min/1.73m2 and in participants with and without albuminuria. The association was evident in per-protocol
analyses which required continuation of the antihyperglycemic medication during follow up (HR=0.64 (0.60-0.70)), and in analyses requiring concurrent use of metformin in at least the first 90 days of follow up (HR=0.63 (0.57-0.69)).

Conclusion

Among people with diabetes mellitus type 2, SGLT2i use was associated with eGFR preservation, greater decline in BMI, and reduced risk of MAKE compared to other antihyperglycemics.

Funding

  • Veterans Affairs Support