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Kidney Week

Abstract: PO2282

Association of SGLT2 Inhibitors and DPP-4 Inhibitors vs. GLP-1 Agonists with Incident CKD in US Veterans

Session Information

Category: CKD (Non-Dialysis)

  • 2101 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention

Authors

  • Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States
  • Rhee, Connie, University of California Irvine, Irvine, California, United States
  • Narasaki, Yoko, University of California Irvine, Irvine, California, United States
  • You, Amy Seung, University of California Irvine, Irvine, California, 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
  • Potukuchi, Praveen Kumar, The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
  • Kovesdy, Csaba P., The University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, United States
Background

Randomized controlled trials (RCTs) have demonstrated that SGLT2 inhibitors (SGLT2i) reduce the risk of eGFR decline and ESRD as compared with placebo in patients with pre-existing CKD. These RCTs showed an initial dip in eGFR with initiation of SGLT2i that stabilized over time. Little is known about the impact SGLT2i vs. other newer anti-diabetic medications (DPP-4 inhibitors [DPP4i], GLP1 agonists [GLP1a]) upon risk of developing de novo kidney dysfunction in patients without underlying CKD.

Methods

Among US Veterans with diabetes and absence of pre-existing CKD (normal eGFR and no proteinuria) followed over 2004-18, we identified incident (new) users of SGLT2i vs. DPP4i vs. GLP1a therapy, excluding combined users of the examined classes. We examined associations of SGLT2i vs. DPP4i vs. GLP1a use with the risk of incident CKD (primary outcome) and ESRD (secondary outcome) using multivariable Cox models.

Results

Among 39,065 diabetic patients without pre-existing CKD, 15%, 70%, vs. 15% were new users of SGLT2i, DPP4i, vs. GLP1a, respectively. Compared to DPP4i, use of SGLT2i and GLP1a were each associated with higher risk of incident CKD: adjusted HRs (aHRs) (95%CI) 1.32 (1.18-1.47) and 1.20 (1.11-1.31), respectively (Figure 1A). However, use of SGLT2i and GLP1a were not associated with higher risk of de novo ESRD: adjusted HRs (aHRs) (95%CI) 1.20 (0.15-9.32) and 0.62 (0.24-1.57), respectively (Figure 1B).

Conclusion

In a national cohort of diabetic US Veterans without pre-existing CKD, SGLT2i and GLP1a use were each associated with higher risk of incident CKD as compared with DPP4i use. However, neither medication was associated with incident ESRD, suggesting that early decline with SGLT2i and GLP1a use may be an acute/subacute effect that stabilizes over time.

Funding

  • Veterans Affairs Support