Association of acute increases in serum creatinine with subsequent outcomes in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitor or dipeptidyl peptidase-4 inhibitor
Authors' conclusion
A modest increase in serum creatinine (<30%) was common following SGLT2i initiation, and was not associated with worse clinical outcomes
Study context
- Population
- Patients with T2DM starting SGLT2i or DPP4i, multicentre health care provider in Taiwan, 1 June 2016 to 31 December 2018SGLT2i 11,657
- Exposure
- Initial serum creatinine (sCr) increase >30% vs 0-30% vs no increase after SGLT2i or DPP4i initiation
- Outcome
- Outcomes with initial sCr increase >30% vs no increase, SGLT2i
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
>30% sCr increase vs No-sCr increaseAdjusted hazard ratio (95% CI)
MACE
2.91(1.37–6.17)
HF hospitalization
1.91(1.08–3.40)
Composite renal outcome
1.53(1.05–2.25)
Observational data: associations, not effects.
Further findings
Frequency of sCr increase, SGLT2i vs DPP4i · within 12 weeks
sCr increase 0-30%
sCr increase >30%
| Outcome | aHR (95% CI) | |
|---|---|---|
| Outcomes, SGLT2ivs DPP4i overallHF hospitalization | 0.64 (0.48–0.85) | |
| Outcomes, SGLT2ivs DPP4i overallComposite renal outcomes | 0.40 (0.34–0.48) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
- Outcomes, SGLT2i vs DPP4i overall: benefit persistent across three sCr categories (P interaction > 0.05)
eGFR over time
- With SGLT2i, unlike DPP4i, mean eGFR became stable after 24 weeks in all three sCr categories
Original publication
Association of acute increases in serum creatinine with subsequent outcomes in patients with type 2 diabetes mellitus treated with sodium–glucose cotransporter 2 inhibitor or dipeptidyl peptidase-4 inhibitor. Eur Heart J Qual Care Clin Outcomes. Published 7 July 2022. doi:10.
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