ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: PO0750

Comparative Effectiveness of SGLT-2 Inhibitors, DPP-4 Inhibitors, and GLP-1 Agonists in US Veterans with and Without CKD

Session Information

Category: Diabetic Kidney Disease

  • 602 Diabetic Kidney Disease: Clinical

Authors

  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • You, Amy Seung, University of California Irvine, Irvine, California, United States
  • Potukuchi, Praveen Kumar, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Dashputre, Ankur A., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Sumida, Keiichi, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Thomas, Fridtjof, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Streja, Elani, University of California Irvine, Irvine, California, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
Background

Recent clinical trials have shown that SGLT2 inhibitors (SGLT2i) vs. placebo substantially reduce the risk of eGFR decline, ESRD, and renal-/CV-related mortality in CKD patients. However, little is known about the comparative effectiveness of SGLT2i vs. other newer anti-diabetic medications (DPP-4 inhibitors [DPP4i], GLP1 agonists [GLP1a]) on CKD outcomes using real-world data in patients with and without CKD.

Methods

In US Veterans with diabetes receiving care from the VA healthcare system over 2004-18, we identified incident (new) users of SGLT2i vs. DPP4i vs. GLP1a therapy, excluding combined users of the examined classes. In analyses stratified by presence vs. absence of CKD defined by eGFR and albuminuria levels, we examined associations of SGLT2i vs. DPP4i vs. GLP1a use with the composite outcome of incident ESRD+all-cause death using multivariable Cox models.

Results

In 64,564 patients who met eligibility criteria, 51% patients had CKD, and 8%, 77%, vs. 15% were new users of SGLT2i, DPP4i, vs. GLP1a, respectively. Patients contributed a total of 182,177 person-years of follow up, during which 10,861 incident ESRD/death events were observed (crude rate 59.6 events/1000 person-years). Median (IQR) at-risk time was 2.1 (0.9, 4.0) years. Compared to DPP4i, use of SGLT2i was associated with lower risk of the composite outcome across all Cox models (adjusted HR [95%CI] 0.86 [0.75-1.00]). The beneficial association of SGLT2i use with the composite outcome was limited to patients with pre-existing CKD. Across all cohorts (overall, CKD, non-CKD), GLP1a had comparable risk of the composite outcome when compared to DPP4i in adjusted analyses.

Conclusion

In a national cohort of US Veterans with diabetes, SGLT2i use was associated with lower risk of the composite outcome of ESRD+mortality in CKD patients, yet had comparable risk to DPP4i in those without CKD. Further studies are needed to determine the long-term safety and effectiveness of novel anti-diabetic medications using real-world data.

Funding

  • Veterans Affairs Support