Background Despite the overall improvement in care, people with type 2 diabetes (T2D) experience an excess risk of end-stage kidney disease. We evaluated the long-term effectiveness of dapagliflozin on kidney function and albuminuria in patients with T2D. Methods We included patients with T2D who initiated dapagliflozin or comparators from 2015 to 2020. Propensity score matching (PSM) was performed to balance the two groups. The primary endpoint was the change in estimated glomerular filtration rate (eGFR) from baseline to the end of observation. Secondary endpoints included changes in albuminuria and loss of kidney function. Findings We analysed two matched groups of 6197 patients each. The comparator group included DPP-4 inhibitors (40%), GLP-1RA (22.3%), sulphonylureas (16.1%), pioglitazone (8%), metformin (5.8%), or acarbose (4%). Only 6.4% had baseline eGFR <60 ml/min/1.73 m(2) and 15% had UACR >30 mg/g. During a mean follow-up of 2.5 year, eGFR declined significantly less in the dapagliflozin vs comparator group by 1.81 ml/min/1.73 m(2) (95% C.I. from 1.13 to 2.48; p < 0.0001). The mean eGFR slope was significantly less negative in the dapagliflozin group by 0.67 ml/min/1.73 m(2)/year (95% C.I. from 0.47 to 0.88; p < 0.0001). Albuminuria declined significantly in new-users of dapagliflozin within 6 months and remained on average 44.3 mg/g lower (95% C.I. from-66.9 to-21.7; p < 0.0001) than in new-users of comparators. New-users of dapagliflozin had significantly lower rates of new-onset CKD, loss of kidney function, and a composite renal outcome. Results were confirmed for all SGLT2 inhibitors, in patients without baseline CKD, and when GLP-1RA were excluded from comparators. Interpretation Initiating dapagliflozin improved kidney function outcomes and albuminuria in patients with T2D and a low renal risk. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Long-term benefits of dapagliflozin on renal outcomes of type 2 diabetes under routine care: a comparative effectiveness study on propensity score matched cohorts at low renal risk

Zavattaro, Marco
Membro del Collaboration Group
;
Aimaretti, Gianluca
Membro del Collaboration Group
;
Beccuti, Guglielmo
Membro del Collaboration Group
;
Broglio, Fabio
Membro del Collaboration Group
;
2024-01-01

Abstract

Background Despite the overall improvement in care, people with type 2 diabetes (T2D) experience an excess risk of end-stage kidney disease. We evaluated the long-term effectiveness of dapagliflozin on kidney function and albuminuria in patients with T2D. Methods We included patients with T2D who initiated dapagliflozin or comparators from 2015 to 2020. Propensity score matching (PSM) was performed to balance the two groups. The primary endpoint was the change in estimated glomerular filtration rate (eGFR) from baseline to the end of observation. Secondary endpoints included changes in albuminuria and loss of kidney function. Findings We analysed two matched groups of 6197 patients each. The comparator group included DPP-4 inhibitors (40%), GLP-1RA (22.3%), sulphonylureas (16.1%), pioglitazone (8%), metformin (5.8%), or acarbose (4%). Only 6.4% had baseline eGFR <60 ml/min/1.73 m(2) and 15% had UACR >30 mg/g. During a mean follow-up of 2.5 year, eGFR declined significantly less in the dapagliflozin vs comparator group by 1.81 ml/min/1.73 m(2) (95% C.I. from 1.13 to 2.48; p < 0.0001). The mean eGFR slope was significantly less negative in the dapagliflozin group by 0.67 ml/min/1.73 m(2)/year (95% C.I. from 0.47 to 0.88; p < 0.0001). Albuminuria declined significantly in new-users of dapagliflozin within 6 months and remained on average 44.3 mg/g lower (95% C.I. from-66.9 to-21.7; p < 0.0001) than in new-users of comparators. New-users of dapagliflozin had significantly lower rates of new-onset CKD, loss of kidney function, and a composite renal outcome. Results were confirmed for all SGLT2 inhibitors, in patients without baseline CKD, and when GLP-1RA were excluded from comparators. Interpretation Initiating dapagliflozin improved kidney function outcomes and albuminuria in patients with T2D and a low renal risk. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
2024
38
1
14
Chronic kidney disease; Observational; Prevention; SGLT2 inhibitors; Type 2 diabetes
Fadini, Gian Paolo; Longato, Enrico; Morieri, Mario Luca; Del Prato, Stefano; Avogaro, Angelo; Solini, Anna; Baldassarre, Mariella; Consoli, Agostino; Morganet, Sara; Zugaro, Antonella; Baroni, Marco Giorgio; Andreozzi, Francesco; Gatti, Adriano; Gatti, Adriano; De Riu, Stefano; Del Buono, Andrea; Aldigeri, Raffaella; Bonadonna, Riccardo; Cas, Alessandra Dei; Vazzana, Angela; Antonini, Monica; Moretti, Valentina; Volsi, Patrizia Li; Cesare, Miranda; Zanette, Giorgio; Carletti, Silvia; D'Angelo, Paola; Leto, Gaetano; Leonetti, Frida; D'Onofrio, Luca; Maddaloni, Ernesto; Buzzetti, Raffaella; Frontoni, Simona; Cavallo, Giselle; Morano, Susanna; Filardi, Tiziana; Capece, Umberto; Giaccari, Andrea; Bossi, Antonio C.; Meregalli, Giancarla; Querci, Fabrizio; Gaglio, Alessia; Resi, Veronica; Orsi, Emanuela; Fazion, Stefano; Franzetti, Ivano G.; Berra, Cesare; Manfrini, Silvia; Garrapa, Gabriella; Lucarelli, Giulio; Riccialdelli, Lara; Tortato, Elena; Zavattaro, Marco; Aimaretti, Gianluca; Cavalot, Franco; Beccuti, Guglielmo; Broglio, Fabio; Fattor, Bruno; Cazzetta, Giuliana; Lamacchia, Olga; Rauseo, Anna; De Cosmo, Salvatore; Cau, Rosella; Ghiani, Mariangela; Di Benedetto, Antonino; Di Pino, Antonino; Piro, Salvatore; Purrello, Francesco; Frittitta, Lucia; Milluzzo, Agostino; Russo, Giuseppina
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1965330
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