|Title:||Improvement in Mortality and End-Stage Renal Disease in Patients With Type 2 Diabetes After Acute Kidney Injury Who Are Prescribed Dipeptidyl Peptidase-4 Inhibitors||Authors:||Chen C.-Y.
|Issue Date:||2018||Publisher:||Elsevier Ltd||Journal Volume:||93||Journal Issue:||12||Start page/Pages:||1760-1774||Source:||Mayo Clinic Proceedings||Abstract:||
Objective: To focus on the potential beneficial effects of the pleiotropic effects of dipeptidyl peptidase-4 inhibitors (DPP4is) on attenuating progression of diabetic kidney disease in reducing the long-term effect of the acute kidney injury (AKI) to chronic kidney disease (CKD) transition. Patients and Methods: Data from the National Health Insurance Research Database from January 1, 1999, to July 31, 2011, were analyzed, and patients with diabetes weaning from dialysis-requiring AKI were identified. Cox proportional hazards models and inverse-weighted estimates of the probability of treatment were used to adjust for treatment selection bias. The outcomes were incident end-stage renal disease (ESRD) and mortality, major adverse cardiovascular events, and hospitalized heart failure. Results: Of a total of 6165 patients with diabetes weaning from dialysis-requiring AKI identified, 5635 (91.4%) patients were DPP4i nonusers and 530 (8.6%) patients were DPP4i users. Compared with DPP4i nonusers, DPP4i users had a lower risk of ESRD (hazard ratio, 0.81; 95% CI, 0.70-0.94; P=.04) and all-cause mortality (hazard ratio, 0.28; 95% CI, 0.23-0.34; P<.001) after adjustments for CKD, advanced CKD, and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker use. In contrast, the risk of major adverse cardiovascular events and hospitalized heart failure did not differ significantly between groups. Conclusion: Dipeptidyl peptidase-4 inhibitor users had a lower risk of ESRD and mortality than did nonusers among patients with diabetes after weaning from dialysis-requiring AKI. Therefore, a prospective study of AKI to CKD transitions after episodes of AKI is needed to optimally target DPP4i interventions. ? 2018 Mayo Foundation for Medical Education and Research
|ISSN:||0025-6196||DOI:||10.1016/j.mayocp.2018.06.023||SDG/Keyword:||alpha glucosidase inhibitor; angiotensin receptor antagonist; antidiabetic agent; dipeptidyl carboxypeptidase inhibitor; dipeptidyl peptidase IV inhibitor; glitazone derivative; insulin; meglitinide; metformin; sulfonylurea; dipeptidyl peptidase IV inhibitor; acute kidney failure; adult; aged; all cause mortality; Article; cardiovascular risk; cohort analysis; controlled study; dialysis; drug effect; drug potentiation; end stage renal disease; female; heart failure; human; major adverse cardiac event; major clinical study; male; mortality; non insulin dependent diabetes mellitus; outcome assessment; acute kidney failure; case control study; chronic kidney failure; complication; diabetic nephropathy; disease exacerbation; middle aged; non insulin dependent diabetes mellitus; proportional hazards model; prospective study; Acute Kidney Injury; Adult; Aged; Case-Control Studies; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Dipeptidyl-Peptidase IV Inhibitors; Disease Progression; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Proportional Hazards Models; Prospective Studies
|Appears in Collections:||醫學系|
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