Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis

Lui, David Tak Wai; Au, Ivan Chi Ho; Tang, Eric Ho Man; Cheung, Ching‐Lung; Lee, Chi H.; Woo, Yu Cho; Wu, Tingting; Tan, Kathryn Choon Beng; Wong, Carlos King Ho

doi:10.1016/j.eclinm.2022.101510

Cited by 18 publications

(22 citation statements)

References 32 publications

(35 reference statements)

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“…[12] In comparison to other types of medication, SGLT2 inhibitors use was associated with a lower risk of composite kidney outcomes and a lower incidence of ESKD (end-stage kidney disease) than GLP1RA use. [13]…”

Section: Resultsmentioning

confidence: 99%

Impact of SGLT2 inhibitors treatment on the chronic kidney disease in people with type 2 diabetes

CZARKOWSKI

Raksa

Powroźniak

et al. 2022

J Educ Health Sport

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Diabetes is the most common cause of CKD (chronic kidney disease). CKD is also one of the most important diabetic complication. SGLT2 (sodium glucose co‐transporter‐2) inhibitors are new class of medication used to lower high blood glucose level in people with type 2 diabetes. In new researches SGLT2 inhibitors demonstrated a significant and clinically relevant reduction in the risks of albuminuria and progression of nephropathy, doubling of serum creatinine levels, and initiation of renal replacement therapy. This review focuses on the therapeutic effectiveness of using SGLT2 inhibitors for the treatment of CKD in type 2 diabetes.

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Section: Resultsmentioning

confidence: 99%

Impact of SGLT2 inhibitors treatment on the chronic kidney disease in people with type 2 diabetes

CZARKOWSKI

Raksa

Powroźniak

et al. 2022

J Educ Health Sport

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“…The Hospital Authority is the statutory body that provides public healthcare services in outpatient clinics and all public hospitals in Hong Kong, covering 90% of all secondary and tertiary care in the territory [ 9 ]. The service is available to all Hong Kong residents (> 7.3 million) [ 10 ]. Electronic medical records of patients include demographics, registered death records, laboratory tests, disease diagnoses, procedures, medication dispensing records, hospital admissions, outpatient and emergency department visits.…”

Section: Methodsmentioning

confidence: 99%

“…Electronic medical records of patients include demographics, registered death records, laboratory tests, disease diagnoses, procedures, medication dispensing records, hospital admissions, outpatient and emergency department visits. Data from this database have been commonly used in diabetes-related research [ 10 , 11 ]. Patients with type 2 diabetes managed in the Hospital Authority public health clinics receive regular diabetic complication screening.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with type 2 diabetes managed in the Hospital Authority public health clinics receive regular diabetic complication screening. During each diabetic complication screening session, patients are assessed clinically and have laboratory investigations to determine their control of diabetes, its related cardiovascular risk factors and the presence of diabetic complications [ 10 , 12 ]. Comorbidities are also recorded by clinicians as diagnosis codes of International Classification of Primary Care, second edition (ICPC-2) or the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) when patients attend any clinic visits or are hospitalized.…”

Section: Methodsmentioning

confidence: 99%

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Risks of stroke, its subtypes and atrial fibrillation associated with glucagon-like peptide 1 receptor agonists versus sodium-glucose cotransporter 2 inhibitors: a real-world population-based cohort study in Hong Kong

Lui

Tang

et al. 2023

Cardiovasc Diabetol

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Background There are limited data on head-to-head comparative risk of stroke between sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA). We compared risk of stroke with its subtypes and incident atrial fibrillation (AF) between them. Methods A population-based, retrospective cohort of patients with type 2 diabetes between 2008 and 2020 were identified from the electronic health records of Hong Kong Hospital Authority. Patients who received SGLT2i or GLP-1RA were matched pairwise by propensity score. Risks of stroke and AF were evaluated by hazard ratios (HRs) from the Cox proportional hazard regression models. Results A total of 5840 patients (2920 SGLT2i users; 2920 GLP-1RA users) were included (mean age 55.5 years, 56.1% men, mean HbA1c 8.9% and duration of diabetes 13.7 years). Upon median follow-up of 17 months, there were 111 (1.9%) events of stroke (SGLT2i: 62, 2.1%; GLP-1RA: 49 1.7%). SGLT2i users had comparable risk of all stroke as GLP-1RA users (HR 1.46, 95% CI 0.99–2.17, p = 0.058). SGLT2i users had higher risk of ischemic stroke (HR 1.53, 95% CI 1.01–2.33, p = 0.044) but similar risk of hemorrhagic stroke compared to GLP-1RA users. Although SGLT2i was associated with lower risk of incident AF (HR 0.43, 95% CI 0.23–0.79, p = 0.006), risk of cardioembolic stroke was similar. Conclusions Our real-world study demonstrated that GLP-1RA use was associated with lower risk of ischemic stroke, despite the association between SGLT2i use and lower risk of incident AF. There was no significant difference in hemorrhagic stroke risk. GLP-1RA may be the preferred agent for patients with type 2 diabetes at risk of ischemic stroke.

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“…Moreover, efpeglenatide, an exendin-4-based GLP1-RA, also led to favorable renal outcomes compared to placebo in the AMPLITUDE-O trial of individuals with T2DM, irrespective of eGFR and concurrent sodium-glucose co-transporter-2 (SGLT2) inhibitor use[ 101 , 102 ]. As far as head-to-head comparisons, the renoprotective effects of GLP1-RAs were of greater magnitude compared with dipeptidyl peptidase-4 inhibitors[ 103 ], whereas SGLT2 inhibitors may promote increased renal benefits[ 104 , 105 ].…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Interplay between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: Epidemiology, pathophysiologic mechanisms, and treatment considerations

Theofilis¹,

Vordoni²,

Kalaitzidis³

2022

World J Gastroenterol

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The recently proposed nomenclature change from non-alcoholic fatty liver disease to metabolic dysfunction-associated fatty liver disease (MAFLD) has resulted in the reappraisal of epidemiological trends and associations with other chronic diseases. In this context, MAFLD appears to be tightly linked to incident chronic kidney disease (CKD). This association may be attributed to multiple shared risk factors including type 2 diabetes mellitus, arterial hypertension, obesity, dyslipidemia, and insulin resistance. Moreover, similarities in their molecular pathophysiologic mechanisms can be detected, since inflammation, oxidative stress, fibrosis, and gut dysbiosis are highly prevalent in these pathologic states. At the same time, lines of evidence suggest a genetic predisposition to MAFLD due to gene polymorphisms, such as the PNPLA3 rs738409 G allele polymorphism, which may also propagate renal dysfunction. Concerning their management, available treatment considerations for obesity (bariatric surgery) and novel antidiabetic agents (glucagon-like peptide 1 receptor agonists, sodium-glucose co-transporter 2 inhibitors) appear beneficial in preclinical and clinical studies of MAFLD and CKD modeling. Moreover, alternative approaches such as melatonin supplementation, farnesoid X receptor agonists, and gut microbiota modulation may represent attractive options in the future. With a look to the future, additional adequately sized studies are required, focusing on preventing renal complications in patients with MAFLD and the appropriate management of individuals with concomitant MAFLD and CKD.

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Kidney outcomes associated with sodium-glucose cotransporter 2 inhibitors versus glucagon-like peptide 1 receptor agonists: A real-world population-based analysis

Cited by 18 publications

References 32 publications

Impact of SGLT2 inhibitors treatment on the chronic kidney disease in people with type 2 diabetes

Impact of SGLT2 inhibitors treatment on the chronic kidney disease in people with type 2 diabetes

Risks of stroke, its subtypes and atrial fibrillation associated with glucagon-like peptide 1 receptor agonists versus sodium-glucose cotransporter 2 inhibitors: a real-world population-based cohort study in Hong Kong

Interplay between metabolic dysfunction-associated fatty liver disease and chronic kidney disease: Epidemiology, pathophysiologic mechanisms, and treatment considerations

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