SGLT2 inhibitors may improve kidney outcomes for Asian adults with type 2 diabetes
Key takeaways:
- Starting SGLT2 inhibitors led to a lower risk of eGFR decline or incident kidney failure.
- SGLT2 inhibitors were also linked to reduced amputation and AKI risks.
Use of SGLT2 inhibitors was associated with improved kidney health among a diverse multiethnic cohort of Asian adults with type 2 diabetes, researchers found in a retrospective cohort study.
Diabetes is a “major contributor to the rising global burden of chronic kidney disease associated with significant morbidity, high mortality and reduced quality of life,” Liang Feng, PhD, a principal research scientist at the Duke-NUS Medical School program in health services and systems research in Singapore, wrote with colleagues. “Studies indicate Asian populations face an elevated risk of type 2 diabetes and accelerated progression to adverse vascular complications including CKD compared to their European counterparts.”
Investigators used data from the SingHealth Diabetes Registry in Singapore to analyze the effects of SGLT2 inhibitors on kidney and safety outcomes in patients with type 2 diabetes in a clinical setting. Overall, 4,254 patients who started on SGLT2 inhibitors or other glucose-lowering medications from 2014 to 2018 were included: 2,127 patients were in each group.
Mean age of the cohort was 63.4 years; 48.6% of patients were women. Overall, 67.8% were Chinese; 11.9% were Indian; 15.6% were Malay; and the remaining 4.7% fell into other categories.
The composite kidney outcome included an eGFR decline of at least 40% or incident kidney failure with replacement therapy, rate of eGFR change, amputation and AKI.
Median follow-up was 25.6 months.
Starting SGLT2 inhibitors vs. no use of SGLT2 inhibitors was associated with a lower risk of the composite outcome (HR = 0.39; 95% CI, 0.31-0.48); and at least a 40% eGFR reduction from baseline (HR = 0.38; 95% CI, 0.31-0.48). SGLT2 inhibitor treatment was also linked to a reduced rate of eGFR decline, Feng and colleagues noted, with a difference in slope of 2.67 mL/min per 1.73 m² per year (95% CI, 1.9-3.43) among the 1,888 patients in the intention-to-treat population.
“In our study of a real-world cohort of multiethnic patients ... SGLT2 inhibitors had a sizeable protective effect on preserving kidney function but no association with amputation when compared with anti-diabetic regimens without SGLT2 inhibitors,” the researchers wrote. SGLT2 inhibitors also lowered AKI risk, but “more work needs to be done to optimize their utilization, especially in high-risk populations in Asia and beyond.”
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