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Higher-Dose Sitagliptin and the Risk of Congestive Heart Failure in Older Adults with CKD

Flory T Muanda1,2, Matthew A Weir1,2,3, Lavanya Bathini1,3

  • 1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada.

Clinical Journal of the American Society of Nephrology : CJASN
|November 26, 2020
PubMed

Insights

Higher doses of sitagliptin (a dipeptidyl peptidase-4 inhibitor) did not increase the risk of death or heart failure hospitalization in older adults with chronic kidney disease (CKD). This finding supports current prescribing practices for type 2 diabetes management in CKD patients.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Sitagliptin, a DPP-4 inhibitor, is used for type 2 diabetes.
  • Renal impairment necessitates dose adjustment for sitagliptin.
  • Concerns exist regarding sitagliptin's association with congestive heart failure, especially at higher doses.

Purpose of the Study:

  • To compare the 1-year risk of death or hospitalization for congestive heart failure.
  • To evaluate outcomes in CKD patients newly prescribed sitagliptin at >50 mg/d versus ≤50 mg/d.

Main Methods:

  • Population-based cohort study of older adults (>66 years) with type 2 diabetes and CKD (eGFR <45 ml/min/1.73 m²).
  • Used inverse probability of treatment weighting (IPTW) based on propensity scores.
  • Primary outcome: composite of death or hospitalization for congestive heart failure; secondary outcomes: pancreatitis, hypoglycemia, all-cause hospitalization, glycemic control.

Main Results:

  • No significant difference in the 1-year risk of death or congestive heart failure hospitalization between groups (WHR, 0.88; 95% CI, 0.67-1.14).
  • Hospitalization for pancreatitis (WHR, 0.98; 95% CI, 0.32-3.03) and hypoglycemia (WHR, 1.10; 95% CI, 0.64-1.90) did not differ significantly.
  • Patients on >50 mg/d had lower mean HbA1c and a reduced risk of all-cause hospitalization (WHR, 0.81; 95% CI, 0.66-0.98).

Conclusions:

  • The risk of death or congestive heart failure was not elevated in older adults with CKD initiating sitagliptin at >50 mg/d compared to ≤50 mg/d.
  • Higher sitagliptin doses did not increase adverse cardiovascular or pancreatitis/hypoglycemia events in this CKD population.
Abstract

Keywords:
chronic kidney diseasedosageheart failuresitagliptintoxicity

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