Long Term Kidney Benefits in Patients with Type 2 Diabetes (T2D) Initiating Empagliflozin vs DPP4 Inhibitors: Real World Data
2Faculty of Medicine, Hebrew University of Jerusalem
3Maccabi Institute for Research and Innovation, Maccabi Healthcare Services
4School of Public Health Sackler, Faculty of Medicine, Tel Aviv University
5Faculty of Medicine, Tel Aviv University
The SGLT2 inhibitor (SGLT2i) empagliflozin (EMPA) improves kidney outcomes in populations with T2D at high cardiovascular (CV) and kidney risk as demonstrated in the EMPGA-REG OUTCOME trial and in real world evidence studies. Yet, limited data is available on long term kidney outcomes with EMPA in general and lower risk populations.
In a large Israeli database (2015-2021), we compared long term kidney outcomes in patients with T2D and eGFR>30 ml/min/1.73 m2 who initiated EMPA (or any SGLT2i) vs DPP4 inhibitors (DPP4i) and were naïve for both drugs 12 month prior index date. Arms were propensity score matched by baseline characteristics. Composite outcome was ≥40% sustained eGFR loss, end stage kidney disease (ESKD) or all-cause mortality. Risk was tested by Cox proportional model, adjusted to baseline eGFR.
Each arm had 7996 patients, most had no atherosclerotic CV disease history (75.5%) or were of low KDIGO risk (65.1%). Median follow up was 35.4 [IQR 20.8-52.3] months. Compared to DPP4i, EMPA arm had lower risk for the main outcome (HR 0.78; 95%CI 0.69-0.88; P<0.001). Findings were consistent when any SGLT2i initiators and DPP4i were matched (HR 0.81; 0.72-0.91; P<0.001), or when a composite endpoint of ≥40% eGFR loss or ESKD were analyzed.
To conclude, the long term follow up enabled to detect kidney benefits for EMPA compared with DPP4i initiation, in a general population composed mostly of patients with low cardiorenal risk.
