Related Experiment Video
Updated: Nov 20, 2025
Author Spotlight: Network Pharmacology and Molecular Docking to Decipher the Action of Jiawei Shengjiang San Against Diabetic Kidney Disease
Published on: May 10, 2024
Dipeptidyl-Peptidase 4 Inhibitors did not Improve Renal Endpoints in Advanced Diabetic Kidney Disease
Edy Kornelius1, Chien-Ning Huang1, Shih-Chang Lo2
1From (1)Chung Shan Medical University Hospital, Department of Internal Medicine, Division of Endocrinology and Metabolism,; School of Medicine of Chung Shan Medical University; Institute of Medicine of Chung Shan Medical University.
Insights
Dipeptidyl-peptidase 4 inhibitors (DPP4is) did not show renal protective benefits in patients with advanced diabetic kidney disease (DKD). This study found no reduction in composite renal endpoints for those prescribed DPP4is compared to controls.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Diabetic kidney disease (DKD) affects millions globally, necessitating effective treatments.
- The role of dipeptidyl-peptidase 4 inhibitors (DPP4is) in mitigating DKD progression remains unclear.
- Advanced DKD patients require interventions to prevent further renal decline.
Purpose of the Study:
- To investigate the renal protective efficacy of DPP4 inhibitors in patients with advanced diabetic kidney disease.
- To determine if DPP4 inhibitors reduce the risk of composite renal endpoints in this population.
Main Methods:
- Retrospective cohort study (2012-2018) in Taiwan.
- Included type 2 diabetes patients with eGFR 30-90 mL/min/1.73 m² and UACR 300-5000 mg/g.
- Compared outcomes between DPP4 inhibitor users (cases) and non-users (controls).
Main Results:
- 522 patients analyzed (273 cases, 249 controls); median follow-up 2.2 vs 3.4 years.
- No significant reduction in composite renal endpoints observed for DPP4i users (HR 1.50, 95% CI 0.95-2.36).
- Similar non-significant findings for persistent low eGFR, creatinine doubling, and end-stage renal disease.
Conclusions:
- DPP4 inhibitor prescription did not demonstrate a benefit in reducing renal endpoints in advanced DKD.
- Further research may be needed to explore alternative therapeutic strategies for DKD.
- Current evidence does not support DPP4is for renal protection in advanced DKD.
Objective:
The efficacy of dipeptidyl-peptidase 4 inhibitors (DPP4is) in advanced diabetic kidney disease (DKD) is unknown. We investigated whether DPP4is confer renal protective benefits in DKD patients.
Methods:
We conducted a retrospective cohort study between 2012 and 2018 in Taiwan. We only included type 2 diabetes patients with estimated glomerular filtration rate (eGFR) between 30 and 90 mL/min/1.73 m2 and urine albumin to creatinine ratio between 300 and 5,000 mg/g. Patients with DPP4i prescriptions were selected as cases, while non-DPP4i users served as controls. We followed these patients until the presence of composite primary renal endpoints, which was defined by the earliest occur-rence of clinical renal outcomes.
Results:
A total of 522 patients were included in the analysis, comprising 273 patients with a DPP4i prescription who were selected as cases and 249 patients without DPP4i prescription who were assigned as controls. Median follow-up duration for DPP4i users and nonusers was 2.2 years and 3.4 years, respectively. At baseline, the mean glycated hemoglobin levels for DPP4i users and nonusers were 8.1% and 8.3%, respectively. Among patients with DPP4i prescriptions, there was no reduction in composite primary renal outcome, with a crude hazard ratio (HR) of 1.50 (95% confidence interval [CI], 0.95 to 2.36). Similar results were observed for the risk of persistent eGFR <15 mL/min/1.73 m2, with a HR of 1.68 (95% CI, 0.90 to 3.13), doubling of serum creatinine level, with a HR of 1.05 (95% CI, 0.15 to 7.45), and end-stage renal disease, with a HR of 0.87 (95% CI, 0.14 to 5.19).
Conclusion:
DPP4i prescription did not reduce the risk of composite renal endpoints in DKD patients.
Abbreviations:
BMI = body mass index; CI = confidence interval; CVOT = cardiovascular outcomes trial; DPP4i = dipeptidyl-peptidase 4 inhibitor; DKD = diabetic kidney disease; eGFR = estimated glomerular filtration rate; ESRD = end-stage renal disease; HbA1c = glycated hemoglobin; HR = hazard ratio; SGLT2i = sodium-glucose cotransporter 2 inhibitor; T2D = type 2 diabetes; UACR = urine albumin to creatinine ratio.
More Related Videos
07:01Delivery of Exogenous Artificially Synthesized miRNA Mimic to the Kidney Using Polyethylenimine Nanoparticles in Several Kidney Disease Mouse Models
Published on: May 10, 2022
10:31Comparative Proteomic Analysis of Whole Kidney, Medulla, and Cortical Tubules in Diabetic Pathogenesis of Kidney Injury in Mice
Published on: May 2, 2025
Related Concept Videos
01:23Dipeptidyl Peptidase 4 Inhibitors
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:24Glucagon-like Receptor Agonists
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
01:11Renal Failure: Dose Adjustments
Reduced renal clearance and elimination rate are common outcomes of renal impairment. These alterations lead to a prolonged elimination half-life and an altered apparent volume of distribution for drugs. As a result, dosage adjustments are typically necessary to maintain optimal drug levels in the body.
However, dosage adjustments...
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
01:25Drug Dosing in Renal Diseases: Dose Adjustments Based on Drug Clearance and Elimination Rate Constant