Novel glucose-lowering drugs and the risk of acute kidney injury in routine care; the Stockholm CREAtinine Measurements (SCREAM) project

Springer Science and Business Media LLC
Jim Alkas1, Alessandro Bosi1, Arvid Sjölander1, Peter Bárány2, Carl‐Gustaf Elinder2, Edouard L Fu3, Juan Jesús Carrero4
1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
2Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
3Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, USA
4Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden

Tóm tắt

Abstract Introduction Little is known about the comparative effects of sodium glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP1-RA), or dipeptidyl peptidase-4 inhibitors (DPP-4i) on the risk of acute kidney injury (AKI) in routine care, which may differ from the controlled setting of trials. Methods Observational study comparing risks of AKI among new users of SGLT2i, GLP1-RA or DPP-4i in the region of Stockholm, Sweden, during 2008–2018. AKI was defined by ICD-10 codes and creatinine-based KDIGO criteria. We used inverse probability of treatment weighting (IPTW) to adjust for 60 potential confounders, weighted Kaplan–Meier curves and Cox regression to estimate hazard ratios and absolute risks. Results We included 17,407 participants who newly initiated DPP-4i (N = 10,605), GLP1-RA (N = 4448) or SGLT2i (N = 2354). Mean age was 63 years (39% women) and median (IQR) eGFR was 89 (73–100) ml/min/1.73 m2. During a median follow-up of 2.5 years, 1411 participants experienced AKI. SGLT2i users had the lowest incidence rate of AKI, 18.3 [CI 95% 14.1–23.4] per 1000 person years, followed by GLP1-RA (22.5; 19.9–25.3) and DPP-4i (26.6; 25–28.2). The weighted 3-year absolute risk for AKI was 5.79% [3.63–8.52] in the SGLT2i group, compared with 7.03% [5.69–8.69] and 7.00% [6.43–7.58] in the GLP1-RA and DPP-4i groups, respectively. The adjusted hazard ratio was 0.73 [CI 95% 0.45–1.16] for SGLT2i vs. DPP-4i, and 0.98 [CI 95% 0.82–1.18] for GLP1-RA vs. DPP-4i. Conclusion This study of routine care patients initiating novel glucose-lowering drugs showed similar occurrence of AKI between therapies, and suggests lower risk for SGLT2i.

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