Polypharmacy influences the renal composite outcome in patients treated with sodium‐glucose cotransporter 2 inhibitors

Kobayashi, Kazuo; Toyoda, Masao; Hatori, Nobuo; Furuki, Takayuki; Sakai, Hiroyuki; Hatori, Yutaka; Sato, Kazuyoshi; Miyakawa, Masaaki; Tamura, Kouichi; Kanamori, Akira

doi:10.1111/cts.13222

Cited by 3 publications

(1 citation statement)

References 28 publications

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“…In our previous study, the decrease in eGFR was slower in patients treated with SGLT2i than in those treated with GLP1Ra during monotherapy (Kobayashi et al, 2022). We hypothesize that this occurred because SGLT2i was administered for a shorter period (24.7 ± 14.5 months) in the present study, and the effect of the initial dip was greater.…”

Section: Discussionmentioning

confidence: 54%

Influence of the combination of SGLT2 inhibitors and GLP-1 receptor agonists on eGFR decline in type 2 diabetes: post-hoc analysis of RECAP study

Muta,

Kobayashi,

Toyoda

et al. 2024

Front. Pharmacol.

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Accumulating evidence has demonstrated that both SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP1Ra) have protective effects in patients with diabetic kidney disease. Combination therapy with SGLT2i and GLP1Ra is commonly used in patients with type 2 diabetes (T2D). We previously reported that in combination therapy of SGLT2i and GLP1Ra, the effect on the renal composite outcome did not differ according to the preceding drug. However, it remains unclear how the initiation of combination therapy is associated with the renal function depending on the preceding drug. In this post hoc analysis, we analyzed a total of 643 T2D patients (GLP1Ra-preceding group, n = 331; SGLT2i-preceding group, n = 312) and investigated the differences in annual eGFR decline. Multiple imputation and propensity score matching were performed to compare the annual eGFR decline. The reduction in annual eGFR decline in the SGLT2i-preceding group (pre: −3.5 ± 9.4 mL/min/1.73 m2/year, post: −0.4 ± 6.3 mL/min/1.73 m2/year, p < 0.001), was significantly smaller after the initiation of GLP1Ra, whereas the GLP1Ra-preceding group tended to slow the eGFR decline but not to a statistically significant extent (pre: −2.0 ± 10.9 mL/min/1.73 m2/year, post: −1.8 ± 5.4 mL/min/1.73 m2/year, p = 0.83) after the initiation of SGLT2i. After the addition of GLP1Ra to SGLT2i-treated patients, slower annual eGFR decline was observed. Our data raise the possibility that the renal benefits—especially annual eGFR decline—of combination therapy with SGLT2i and GLP1Ra may be affected by the preceding drug.

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Section: Discussionmentioning

confidence: 54%

Influence of the combination of SGLT2 inhibitors and GLP-1 receptor agonists on eGFR decline in type 2 diabetes: post-hoc analysis of RECAP study

Muta,

Kobayashi,

Toyoda

et al. 2024

Front. Pharmacol.

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Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease

Nee

Yuan

Narva

et al. 2022

Nephrology Dialysis Transplantation

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For the first time in many years, guideline-directed drug therapies have emerged that offer substantial cardiorenal benefits, improved quality of life and longevity in patients with chronic kidney disease (CKD) and type 2 diabetes. These treatment options include sodium-glucose cotransporter-2 inhibitors (SGLT2i), nonsteroidal mineralocorticoid receptor antagonists (MRA), and glucagon-like peptide-1 receptor agonists (GLP1-RA). However, despite compelling evidence from multiple clinical trials, their uptake has been slow in routine clinical practice, reminiscent of the historical evolution of angiotensin-converting enzyme inhibitor and angiotensin II receptor blocker use. The delay in implementation of these evidence-based therapies highlights the many challenges to optimal CKD care, including: 1) clinical inertia; 2) low CKD awareness; 3) suboptimal kidney disease education among patients and providers; 4) lack of patient and community engagement; 5) multimorbidity and polypharmacy; 6) challenges in the primary care setting; 7) fragmented CKD care; 8) disparities in underserved populations; 9) lack of public policy focused on health equity; and 10) high drug prices. These barriers to optimal cardiorenal outcomes can be ameliorated by a multifaceted approach, using the Chronic Care Model framework, to include patient and provider education, patient self-management programs, shared decision making, electronic clinical decision support tools, quality improvement initiatives, clear practice guidelines, multidisciplinary and collaborative care, provider accountability, and robust health information technology. It is incumbent on the global kidney community to take on a multidimensional perspective of CKD care by addressing patient, community, provider, healthcare system, and policy-level barriers.

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Polypharmacy influences the renal composite outcome in patients treated with sodium‐glucose cotransporter 2 inhibitors

Kobayashi

Toyoda

Hatori

et al. 2022

Clinical Translational Sci

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Polypharmacy is a serious concern in general practice, especially among elder patients; however, the evidence showing significantly poor renal outcomes is not sufficient. This survey was performed to evaluate the effect of polypharmacy on the incidence of the renal composite outcome among a sample of patients with sodium‐glucose cotransporter 2 inhibitor (SGLT2i) treatment. We assessed 624 Japanese patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease who received SGLT2i treatment for greater than 1 year. The patients were classified as those with concomitant treatment, that was limited to the medications for hypertension, T2DM, and dyslipidemia, with greater than or equal to seven medications ( n = 110) and those with less than seven medications ( n = 514). Evaluation of the renal composite outcome was performed by propensity score matching and stratification into quintiles. A subgroup analysis of patients of greater than or equal to 62 years of age and less than 62 years of age was also performed. The incidence of the renal composite outcome was larger in patients with greater than or equal to seven medications than in those with less than seven medications in the propensity score‐matched cohort model (6% vs. 17%, respectively, p = 0.007) and also in the quintile‐stratified analysis (odds ratio [OR], 2.23, 95% confidence interval [CI, 1.21–4.12, p = 0.01). The quintile‐stratified analysis of patients of less than 62 years of age—but not those of greater than or equal to 62 years of age—also showed a significant difference (OR, 3.29, 95% CI, 1.41–7.69, p = 0.006). Polypharmacy appears to be associated to the incidence of the renal composite outcome, especially in young patients.

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Polypharmacy influences the renal composite outcome in patients treated with sodium‐glucose cotransporter 2 inhibitors

Cited by 3 publications

References 28 publications

Influence of the combination of SGLT2 inhibitors and GLP-1 receptor agonists on eGFR decline in type 2 diabetes: post-hoc analysis of RECAP study

Influence of the combination of SGLT2 inhibitors and GLP-1 receptor agonists on eGFR decline in type 2 diabetes: post-hoc analysis of RECAP study

Overcoming barriers to implementing new guideline-directed therapies for chronic kidney disease

Polypharmacy influences the renal composite outcome in patients treated with sodium‐glucose cotransporter 2 inhibitors

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