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Kidney Week

Abstract: PO1028

Preexisting CKD Increases Risk of Metformin Monotherapy Failure in US Veterans with Type 2 Diabetes

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Gosmanova, Elvira O., Albany Stratton VA Medical Center, Albany, New York, United States
  • Gemoets, Darren E., Albany Stratton VA Medical Center, Albany, New York, United States
  • Kaminsky, Laurence S., Albany Stratton VA Medical Center, Albany, New York, United States
  • Kovesdy, Csaba P., Memphis VA Medical Center, Memphis, Tennessee, United States
  • Gosmanov, Aidar R., Albany Stratton VA Medical Center, Albany, New York, United States
Background

Metformin (MET) is increasingly used for treatment of type 2 diabetes (T2D) in patients with chronic kidney disease stage 3 (CKD3); however, it is unknown if rates of MET monotherapy failure differs in patients with and without CKD3.

Methods

This was a retrospective study including 21,142 US Veterans with T2D and estimated glomerular filtration rate (eGFR) >30 ml/min/1.73m2 who initiated MET monotherapy between 01/2010 and 03/2017. CKD3 was established as eGFR 30-59 ml/min/1.73m2. MET monotherapy failure defined as the 1st 90-day gap in MET refill (MET discontinuation) or the addition of 2nd hypoglycemic agent (HA) during 3-yr follow up was compared between patients without and with CKD3 using univariate and multivariate Cox regression analyses adjusted for case-mix.

Results

The mean ± SD age for the total cohort was 59.9 ±1 0.2 yrs, 94.3% were males, 79.7 and 17.3% were Whites and Blacks, respectively. Preexisting CKD3 was present in 1,363 (6.5%) patients. Baseline patients' characteristics were similar between two groups except CKD patients were older (68.7 vs. 59.3 yrs in non-CKD) and had lower eGFR (54.1 vs. 87.4ml/min1.73m2 in non-CKD). In Kaplan-Meyer analysis there were no difference in rates of MET discontinuation or addition of 2nd HA in patients without and with CKD3 (p=0.2 and p=0.09, respectively). However, in the adjusted analyses, patients with CKD3 had a significantly higher risk of MET discontinuation or addition of 2nd line HA (HR, 95% CI 1.15, 1.08-1.22 and 1.45; 1.30-1.61, respectively), as compared with no CKD (Figure 1).

Conclusion

In newly treated patients with T2D the presence of preexisting CKD stage 3 was associated with increased risk of MET monotherapy failure. MET discontinuation may be expected in CKD3 patients with the prorgession of CKD; however, our findings of the increased risk of addition 2nd HA warrant further studies to understand whether hypoglycemic efficacy of MET monotherapy is reduced in CKD stage 3.