PDF(Pubmed)
Abstract：
UNASSIGNED: There is a lack of real-world evidence regarding the impact of concomitant metformin and renin-angiotensin system inhibitors (RASis) on sodium-glucose cotransporter-2 inhibitor (SGLT2i)-associated kidney outcomes. This study was aimed to investigate whether SGLT2i-associated kidney outcomes were modified by the concomitant use of metformin or RASis in patients with type 2 diabetes.
UNASSIGNED: SGLT2i users were identified from three electronic health record databases during May 2016 and December 2017 and categorized into those with and without concomitant use of metformin or RASis. Propensity score matching was performed to minimize baseline differences between groups. Study outcomes were mean estimated glomerular filtration rate (eGFR) change and time to 30%, 40%, and 50% eGFR reductions. A meta-analysis was performed to combine the estimates across databases.
UNASSIGNED: After matching, there were 6,625 and 3,260 SGLT2i users with and without metformin, and 6,654 and 2,746 SGLT2i users with and without RASis, respectively. The eGFR dip was similar in SGLT2i users with and without metformin therapy, but was greater in SGLT2i users with RASis compared to those without RASis. Neither metformin nor RASi use had a significant effect on SGLT2i-associated eGFR reductions, as evidenced by the hazard ratios (95% CIs) of 30% eGFR reductions for SGLT2is with versus without metformin/RASis, namely 1.02 (0.87-1.20)/1.09 (0.92-1.31). Such findings were also observed in the outcomes of 40% and 50% eGFR reductions.
UNASSIGNED: Using metformin or RASis did not modify SGLT2i-associated kidney outcomes in type 2 diabetes.
UNASSIGNED: SGLT2i users were identified from three electronic health record databases during May 2016 and December 2017 and categorized into those with and without concomitant use of metformin or RASis. Propensity score matching was performed to minimize baseline differences between groups. Study outcomes were mean estimated glomerular filtration rate (eGFR) change and time to 30%, 40%, and 50% eGFR reductions. A meta-analysis was performed to combine the estimates across databases.
UNASSIGNED: After matching, there were 6,625 and 3,260 SGLT2i users with and without metformin, and 6,654 and 2,746 SGLT2i users with and without RASis, respectively. The eGFR dip was similar in SGLT2i users with and without metformin therapy, but was greater in SGLT2i users with RASis compared to those without RASis. Neither metformin nor RASi use had a significant effect on SGLT2i-associated eGFR reductions, as evidenced by the hazard ratios (95% CIs) of 30% eGFR reductions for SGLT2is with versus without metformin/RASis, namely 1.02 (0.87-1.20)/1.09 (0.92-1.31). Such findings were also observed in the outcomes of 40% and 50% eGFR reductions.
UNASSIGNED: Using metformin or RASis did not modify SGLT2i-associated kidney outcomes in type 2 diabetes.
摘要：
■缺乏关于二甲双胍和肾素-血管紧张素系统抑制剂(RASis)对钠-葡萄糖协同转运蛋白-2抑制剂(SGLT2i)相关肾脏结局的影响的真实世界证据。本研究旨在调查2型糖尿病患者合并使用二甲双胍或RAS是否改变SGLT2i相关肾脏结局。
■SGLT2i用户在2016年5月和2017年12月期间从三个电子健康记录数据库中被识别，并被分为有和没有同时使用二甲双胍或RASis的用户。进行倾向评分匹配以最小化组间的基线差异。研究结果是平均估计的肾小球滤过率（eGFR）变化和时间达到30％，40%,和50%的eGFR降低。进行了荟萃分析，以结合数据库中的估计值。
■匹配后，有6,625和3,260名SGLT2i用户有和没有二甲双胍，以及6,654和2,746个SGLT2i用户，分别。有和没有二甲双胍治疗的SGLT2i用户的eGFR下降相似，但与没有RAS的用户相比，使用RAS的SGLT2i用户更大。二甲双胍和RASi的使用对SGLT2i相关的eGFR降低均无显著影响，如使用二甲双胍/RASis的SGLT2is降低30%eGFR的危险比(95%CI)所证明的那样，即1.02（0.87-1.20）/1.09（0.92-1.31）。在eGFR降低40％和50％的结果中也观察到了这些发现。
■使用二甲双胍或RASis并未改变2型糖尿病患者SGLT2i相关肾脏结局。
■SGLT2i用户在2016年5月和2017年12月期间从三个电子健康记录数据库中被识别，并被分为有和没有同时使用二甲双胍或RASis的用户。进行倾向评分匹配以最小化组间的基线差异。研究结果是平均估计的肾小球滤过率（eGFR）变化和时间达到30％，40%,和50%的eGFR降低。进行了荟萃分析，以结合数据库中的估计值。
■匹配后，有6,625和3,260名SGLT2i用户有和没有二甲双胍，以及6,654和2,746个SGLT2i用户，分别。有和没有二甲双胍治疗的SGLT2i用户的eGFR下降相似，但与没有RAS的用户相比，使用RAS的SGLT2i用户更大。二甲双胍和RASi的使用对SGLT2i相关的eGFR降低均无显著影响，如使用二甲双胍/RASis的SGLT2is降低30%eGFR的危险比(95%CI)所证明的那样，即1.02（0.87-1.20）/1.09（0.92-1.31）。在eGFR降低40％和50％的结果中也观察到了这些发现。
■使用二甲双胍或RASis并未改变2型糖尿病患者SGLT2i相关肾脏结局。
