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Transitional changes in medication-initiator cohort profiles in persons with chronic kidney disease and type 2
Yuichiro Yano1,2,3, Suguru Okami4, Hiroshi Kanegae5
1NCD Epidemiology Research Center, Shiga University of Medical Science, Otsu, Japan.
Aims:
To describe temporal changes in the characteristics of medication-initiator cohorts in persons with chronic kidney disease (CKD) and type 2 diabetes (T2D).
Materials And Methods:
Adults with CKD and T2D initiating sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) were identified in the Japan Chronic Kidney Disease Database Extension in each of the two study periods (Period I: 1 January 2014-30 June 2021; Period II: 1 July 2021-31 December 2022). For each cohort, baseline characteristics and the standard mean differences (SMD) between periods I and II were assessed.
Results:
During study periods I and II, 1157 and 1122 SGLT-2i, and 329 and 369 GLP-1RA new users were identified, respectively. All four cohorts had similar age, sex and comorbidity patterns, with a mean age spanning 66.1-69.5 years and 60%-70% being male. More than 80% of persons had hypertension and 60% had congestive heart failure. In the SGLT-2i cohorts, we observed a decrease in prior metformin and dipeptidyl peptidase-4 inhibitor use (SMD ≥0.5 and <0.8), and an increase in the number of persons with no T2D medications other than insulin between periods (SMD >0.8). In the GLP-1RA cohorts, there was a medium decrease in persons using insulin.
Conclusions:
With the introduction of new treatments and emerging evidence supporting cardio-renal protective effects in people with CKD and T2D, notable changes in baseline treatment were observed in the medication-initiator cohort characteristics. These findings suggest the earlier use of cardio-renal protective medications in the course of T2D.
Insights
Temporal changes in medication initiation for chronic kidney disease (CKD) and type 2 diabetes (T2D) show earlier use of cardio-renal protective drugs like SGLT-2i and GLP-1RA. These findings highlight evolving treatment patterns in managing T2D with CKD.
Area of Science:
- Nephrology
- Endocrinology
- Cardiology
Background:
- Chronic kidney disease (CKD) and type 2 diabetes (T2D) are significant comorbidities.
- Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) have demonstrated cardio-renal protective effects.
- Understanding temporal trends in medication initiation is crucial for optimizing patient care.
Purpose of the Study:
- To describe temporal changes in the characteristics of medication-initiator cohorts.
- To analyze shifts in patient profiles initiating SGLT-2i or GLP-1RA for CKD and T2D.
Main Methods:
- Retrospective analysis of the Japan Chronic Kidney Disease Database Extension.
- Identification of adult CKD and T2D patients initiating SGLT-2i or GLP-1RA.
- Comparison of baseline characteristics between two study periods (2014-2021 and 2021-2022).
Main Results:
- Similar age, sex, and comorbidity patterns across cohorts (mean age 66.1-69.5 years, 60-70% male).
- Increased initiation of SGLT-2i in patients without prior T2D medications (excluding insulin).
- Decreased use of metformin and dipeptidyl peptidase-4 inhibitors prior to SGLT-2i initiation.
- Medium decrease in insulin use among GLP-1RA initiators.
Conclusions:
- Introduction of new treatments and evidence of cardio-renal benefits have altered baseline treatment characteristics.
- Findings suggest earlier adoption of cardio-renal protective medications in T2D management.
- These shifts indicate a proactive approach to managing cardiovascular and renal risks in T2D patients.
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