Renal outcomes and all-cause death associated with sodium-glucose co-transporter-2 inhibitors versus other glucose-lowering drugs (CVD-REAL 3 Korea)
- Authors
- Koh, Eun Sil; Han, Kyungdo; Nam, You-Seon; Wittbrodt, Eric T.; Fenici, Peter; Kosiborod, Mikhail N.; Heerspink, Hiddo J. L.; Yoo, Soon-Jib; Kwon, Hyuk-Sang
- Issue Date
- Feb-2021
- Publisher
- WILEY
- Keywords
- all& #8208; cause death; ESRD; SGLT& #8208; 2 inhibitor
- Citation
- DIABETES OBESITY & METABOLISM, v.23, no.2, pp.455 - 466
- Journal Title
- DIABETES OBESITY & METABOLISM
- Volume
- 23
- Number
- 2
- Start Page
- 455
- End Page
- 466
- URI
- http://scholarworks.bwise.kr/ssu/handle/2018.sw.ssu/40346
- DOI
- 10.1111/dom.14239
- ISSN
- 1462-8902
- Abstract
- Aims To investigate the effectiveness of sodium-glucose co-transporter-2 (SGLT2) inhibitors on the risk of progression to end-stage renal disease (ESRD) and all-cause mortality in a broad range of patients with type 2 diabetes (T2D) using a Korean nationwide cohort. Materials and Methods Using data from the Korean National Health Insurance Service database from January 2014 to December 2017, a total of 701 674 patients were identified with T2D. We divided these patients into new users of SGLT2 inhibitors and new users of other glucose-lowering drugs (oGLDs). Using propensity scores, patients in the two groups were matched 1:1. We assessed the risk of ESRD and all-cause death. Results There were 45 016 patients in each group, and baseline characteristics were well balanced between the groups. The patients' mean age was 58.1 +/- 10.6 years and mean estimated glomerular filtration rate (eGFR) was 89.2 +/- 27.4 mL/min/1.73m(2), and 8% of patients had proteinuria. We identified 167 incident ESRD cases and 1070 all-cause deaths during follow-up. Use of SGLT2 inhibitors versus oGLDs was associated with a lower risk of ESRD (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.34 to 0.65) and all-cause death (HR 0.82, 95% CI 0.73 to 0.93). In a subgroup analysis by eGFR, initiation of SGLT2 inhibitor treatment, compared with oGLD treatment, was associated with lower risk of progression to ESRD among patients with eGFR 60 to 90 mL/min/1.73m(2) and those with eGFR < 60 mL/min/1.73m(2), and a lower risk of all-cause death was associated with SGLT2 inhibitors versus oGLDs in patients with eGFR >= 90 and 60 to 90 mL/min/1.73m(2). Conclusion In this large nationwide study of Korean patients with T2D, initiation of SGLT2 inhibitors versus oGLDs was associated with lower risk of ESRD and all-cause death.
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