Effects of sodium-glucose cotransporter-2 inhibitors on chronic kidney disease progression: A multi-state parametric survival model
1 Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
2 Department of Surgery, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
3 Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
4 Centre for Public Health, School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Northern Ireland, UK
5 School of Medicine and Public Health, University of Newcastle, Australia
6 Hunter Medical Research Institute, Newcastle, Australia
Abstract
Background: Current guidelines recommend good glycemic control in patients with type 2 diabetes (T2D) to limit the progression of associated complications. This study aimed to compare the rate of chronic kidney disease (CKD) progression between patients who did or did not receive sodium-glucose cotransporter-2 inhibitors (SGLT2i) using a multistate model with two intermediate states (CKD stage 4 and 5) and one absorbing state (death).
Methods: Data from patients with T2D and CKD stage 3 were retrieved for analysis. Patients treated with SGLT2i were matched 1:2 by prescription date with non-SGLT2i patients. The multistate model was constructed from Cox survival regression models specific to each transition stage. Cumulative failure and transition probabilities were estimated from bootstrapping.
Results: Data from 6,582 patients (2,194 SGLT2i and 4,388 non-SGLT2i) were analyzed. At 10-year follow-up, patients in the SGLT2i group were more likely to remain at CKD3 compared to the non-SGLT2i group: 82.3% (95% CI 79.9–84.6%) vs 60.4% (57.6–63.4%). Transition probabilities to CKD4, CKD5, and death were all lower in the SGLT2i group: 11.3% vs 19.8%, 2.4% vs 7.4%, and 4.1% vs 12.4%, respectively.
Conclusions: SGLT2i may delay the decline in renal function and slow CKD progression compared to standard care without SGLT2i.
