Cornel J.H.Bakris G.L.Stevens S.R.Alvarsson M.Bax W.A.LEE-MING CHUANGEngel S.S.Lopes R.D.McGuire D.K.Riefflin A.Rodbard H.W.Sinay I.Tankova T.Wainstein J.Peterson E.D.Holman R.R.2020-06-012020-06-0120160149-5992https://www.scopus.com/inward/record.uri?eid=2-s2.0-85006117462&doi=10.2337%2fdc16-1415&partnerID=40&md5=6d7feb8ffea34ed8aca2717391b9d499https://scholars.lib.ntu.edu.tw/handle/123456789/495573OBJECTIVE To evaluate chronic kidney disease (CKD) and cardiovascular outcomes in TECOS (Clinical trial reg. no. NCT00790205, clinicaltrials.gov) participants with type 2 diabetes and cardiovascular disease treated with sitagliptin, a dipeptidyl peptidase 4 inhibitor, according to baseline estimated glomerular filtration rate (eGFR). RESEARCH DESIGN AND METHODS We used data from14,671 TECOS participants assigned in a double-blind design to receive sitagliptin or placebo added to existing therapy, while aiming for glycemic equipoise between groups. Cardiovascular and CKD outcomes were evaluated over a median period of 3 years, with participants categorized at baseline into eGFR stages 1, 2, 3a, and 3b (?90, 60-89, 45-59, or 30-44 mL/min/1.73 m2, respectively). RESULTS Participants with eGFR stage 3b were older, were more often female, and had a longer duration of diabetes. Four-point major adverse cardiovascular event rates increasedwith lower baseline eGFR (3.52, 3.55, 5.74, and 7.34 events/100 patientyears for stages 1-3b, respectively). Corresponding adjusted hazard ratios for stages 2, 3a, and 3b versus stage 1 were 0.93 (95% CI 0.82-1.06), 1.28 (1.10-1.49), and 1.39 (1.13-1.72), respectively. Sitagliptin therapy was not associated with cardiovascular outcomes for any eGFR stage (interaction P values were all >0.44). Kidney function declined at the same rate in both treatment groups, with a marginally lower but constant eGFR difference (21.3 mL/min/1.73 m2) in those participants who were assigned to sitagliptin. Treatment differences in these eGFR values remained after adjustment for region, baseline eGFR, baseline HbA1c, time of assessment, and within-study HbA1c levels. CONCLUSIONS Impaired kidney function is associated with worse cardiovascular outcomes. Sitagliptin has no clinically significant impact on cardiovascular or CKD outcomes, irrespective of baseline eGFR.[SDGs]SDG3hemoglobin A1c; placebo; sitagliptin; antidiabetic agent; dipeptidyl peptidase IV inhibitor; sitagliptin; adult; age; albuminuria; cardiovascular function; chronic kidney failure; Conference Paper; controlled study; creatinine clearance; disease classification; disease duration; double blind procedure; drug effect; female; gender; glomerulus filtration rate; glycemic control; hemoglobin blood level; human; kidney function; major clinical study; male; non insulin dependent diabetes mellitus; outcome assessment; randomized controlled trial; aged; Cardiovascular Diseases; clinical trial; complication; Diabetes Mellitus, Type 2; drug effects; kidney; middle aged; multicenter study; pathophysiology; Renal Insufficiency, Chronic; treatment outcome; Aged; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Dipeptidyl-Peptidase IV Inhibitors; Double-Blind Method; Female; Glomerular Filtration Rate; Humans; Hypoglycemic Agents; Kidney; Male; Middle Aged; Renal Insufficiency, Chronic; Sitagliptin Phosphate; Treatment Outcomeconference paper10.2337/dc16-1415277427282-s2.0-85006117462