SLGT-2 inhibitors reduce mortality in patients with advanced chronic kidney disease
Presenter: Rochell Issa, MD, Cleveland Clinic, Cleveland, OH
Use of sodium-glucose cotransporter 2 inhibitors was associated with significantly reduced all-cause mortality in patients with advanced chronic kidney disease in this study.
In patients with advanced chronic kidney disease (CKD) stages 4, 5, or 5D (requires dialysis), use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors was associated with a significantly lower risk of all-cause mortality in a retrospective cohort study, according to Rochell Issa, MD, Cleveland Clinic, Cleveland, OH, lead author of this Kidney Week 2024 poster presentation.
While it is known that SGLT-2 inhibitors reduce all-cause mortality in patients with type 2 diabetes, Dr. Issa said it remains unknown whether this beneficial effect is maintained in patients with advanced CKD stages 4 to 5D, irrespective of diabetes status. She noted further that SGLT-2 inhibitors act on the SGLT proteins expressed in the proximal renal convoluted tubules.
The aim of this study was to assess the associations of SGLT-2 inhibitors with all-cause mortality compared against usual care without SGLT-2 inhibitors in patients over age 65 years with CKD stages 4 to 5D. Dr. Issa and colleagues calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause mortality at 6 months and at 1- and 5-year follow-ups by comparing propensity score-matched patient groups. The database review encompassed 40,000 patients with CKD stages 4 to 5D who were prescribed SGLT-2 inhibitors or usual care without SGLT-2 inhibitors.
There were 12,112 patients in the CKD stages 4 and 5 cohorts (mean age 74.8 years, 48% female) and 7,888 individuals in the CKD stage 5D cohorts (mean age 73.3 years, 42% female). The analysis found that the patient groups taking SGLT-2 inhibitors had significantly lower risks for all-cause mortality compared with non-SGLT-2 inhibitor users. The finding was consistent across all CKD stages and time points.
In the CKD stages 4 and 5 patients taking SGLT-2 inhibitors, mortality rates at 6 months, 1 year, and 5 years were 6.4%, 9.2%, and 13.0%, respectively. In comparison, mortality rates for non-SGLT-2 inhibitor users were 9.2% (HR, 0.67; 95% CI, 0.67-0.73), 12.6% (HR, 0.68; 95% CI, 0.63-0.73), and 17.9% (HR, 0.67; 95% CI, 0.62-0.71). In the CKD 5D population treated with SGLT-2 inhibitors, the mortality rates at 6 months, 1 year, and 5 years were 6.9% versus 10.9% for non treated pts (HR, 0.59; 95% CI, 0.53-0.66), 9.3% versus 14.3% (HR, 0.59; 95% CI, 0.54-0.65), and 14.7% versus 21.1% (HR, 0.61; 95% CI, 0.59-0.66).
Dr. Issa concluded, “The use of SGLT-2 inhibitors was associated with a significant lower all-cause mortality risk in patients with advanced CKD stages 4, 5, or 5D.”
Funding
- Other NIH Support