Influence of SGLT2i on Renal Progression in CKD Patients: A Multicenter Real-World Study in China.
Although large randomized control trials have established the renal benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in chronic kidney disease (CKD), real-world evidence in Chinese CKD populations remains scarce. Here we report a multicenter real-world retrospective cohort study of SGLT2i use in hospitalized CKD patients in China.
We enrolled 155,053 adults with CKD from the China Renal Data System (CRDS) databases (January 2002-January 2023). We included patients treated with SGLT2i for at least 3 months. SGLT2i users and nonusers were matched (1:2) using propensity score matching (PSM). The main outcomes included renal, safety, and clinical outcomes. Renal outcomes included the first occurrence of CKD progression, end-stage kidney disease (ESKD), or composite outcomes. Multivariable Cox regression models and cumulative incidence were estimated post-PSM.
Overall, the core analysis included 1,477 SGLT2i users and 2,674 nonusers. The progression of CKD (HR 0.81, 95% confidence interval [CI] 0.69-0.95, p < 0.01), incidence of ESKD (HR 0.26, 95% CI 0.18-0.37, p < 0.001), and composite renal outcome (HR 0.68, 95% CI 0.59-0.77, p < 0.001) were significantly lower in the SGLT2i group compared to the non-SGLT2i group. Additionally, the SGLT2i group experienced lower rates of heart failure, stroke, transient ischemic attack, and severe hypoglycemia but a higher risk of acute pancreatitis compared to the non-SGLT2i group. Additionally, eGFR remains better preserved over 3 years in CKD patients treated with SGLT2i.
These findings suggest that SGLT2i offers substantial renal and cardiovascular benefits for Chinese CKD patients.
We enrolled 155,053 adults with CKD from the China Renal Data System (CRDS) databases (January 2002-January 2023). We included patients treated with SGLT2i for at least 3 months. SGLT2i users and nonusers were matched (1:2) using propensity score matching (PSM). The main outcomes included renal, safety, and clinical outcomes. Renal outcomes included the first occurrence of CKD progression, end-stage kidney disease (ESKD), or composite outcomes. Multivariable Cox regression models and cumulative incidence were estimated post-PSM.
Overall, the core analysis included 1,477 SGLT2i users and 2,674 nonusers. The progression of CKD (HR 0.81, 95% confidence interval [CI] 0.69-0.95, p < 0.01), incidence of ESKD (HR 0.26, 95% CI 0.18-0.37, p < 0.001), and composite renal outcome (HR 0.68, 95% CI 0.59-0.77, p < 0.001) were significantly lower in the SGLT2i group compared to the non-SGLT2i group. Additionally, the SGLT2i group experienced lower rates of heart failure, stroke, transient ischemic attack, and severe hypoglycemia but a higher risk of acute pancreatitis compared to the non-SGLT2i group. Additionally, eGFR remains better preserved over 3 years in CKD patients treated with SGLT2i.
These findings suggest that SGLT2i offers substantial renal and cardiovascular benefits for Chinese CKD patients.
Authors
Guo Guo, Su Su, Wang Wang, Li Li, Wu Wu, Wen Wen, Gong Gong, Hou Hou, Liu Liu,
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