Use of glucagon-like peptide-1-receptor-agonists and risk of serious renal events: Scandinavian cohort study

Objective To assess the association between use of GLP1-receptor-agonists and risk of serious renal events in routine clinical practice. Research Design and Methods Cohort study using an active-comparator new-user design and nationwide register data from Sweden, Denmark and Norway, 2010-2016. The cohort included 38,731 new users of GLP1-receptor-agonists (liraglutide 92.5%; exenatide 6.2%; lixisenatide 0.7%; dulaglutide 0.6%), matched 1:1 on age, sex and propensity score to a new user of the active comparator, dipeptidyl-peptidase-4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years. Results Mean (SD) age of the study population was 59 (10) years and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP1-receptor-agonists (incidence rate 4.8 events per 1000 person-years) and in 722 users of DPP4 inhibitors (6.3 events per 1000 person-years; hazard ratio [HR] 0.76, 95% CI 0.68-0.85; absolute difference -1.5 [-2.1 to -0.9] events per 1000 person-years). Use of GLP1-receptor-agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62-0.87]) and hospitalization for renal events (HR 0.73 [0.65-0.83]) but not death from renal causes (HR 0.72 [0.48-1.10]). When using an as-treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49-0.74). Conclusion In this large cohort of patients seen in routine clinical practice in three countries, use of GLP1-receptor-agonists, as compared with DPP4 inhibitors, was associated with a reduced risk of serious renal events.

Download Full-text

Use of glucagon-like peptide-1-receptor-agonists and risk of serious renal events: Scandinavian cohort study

10.2337/dc20-1234/suppl.12016407 ◽

2020 ◽

Author(s):

Björn Pasternak ◽

Viktor Wintzell ◽

Björn Eliasson ◽

Ann-Marie Svensson ◽

Stefan Franzén ◽

...

Keyword(s):

Cohort Study ◽

Clinical Practice ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Routine Clinical Practice ◽

Absolute Difference ◽

Active Comparator ◽

Dipeptidyl Peptidase 4 ◽

Receptor Agonists ◽

Dpp4 Inhibitors

Download Full-text

Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events: Scandinavian cohort study

BMJ ◽

10.1136/bmj.m1186 ◽

2020 ◽

pp. m1186 ◽

Cited By ~ 9

Author(s):

Björn Pasternak ◽

Viktor Wintzell ◽

Mads Melbye ◽

Björn Eliasson ◽

Ann-Marie Svensson ◽

...

Keyword(s):

Cohort Study ◽

Renal Replacement Therapy ◽

Dipeptidyl Peptidase ◽

Hazard Ratio ◽

Sglt2 Inhibitors ◽

Active Comparator ◽

Dipeptidyl Peptidase 4 ◽

Dipeptidyl Peptidase 4 Inhibitors ◽

Reduced Risk

AbstractObjectiveTo assess the association between use of sodium-glucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice.DesignCohort study using an active comparator, new user design and nationwide register data.SettingSweden, Denmark, and Norway, 2013-18.ParticipantsCohort of 29 887 new users of SGLT2 inhibitors (follow-up time: dapagliflozin 66.1%; empagliflozin 32.6%; canagliflozin 1.3%) and 29 887 new users of an active comparator, dipeptidyl peptidase-4 inhibitors, matched 1:1 on the basis of a propensity score with 57 variables. Mean follow-up time was 1.7 (SD 1.0) years.ExposuresSGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors, defined by filled prescriptions and analysed according to intention to treat.Main outcome measuresThe main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospital admission for renal events. Secondary outcomes were the individual components of the main outcome.ResultsThe mean age of the study population was 61.3 (SD 10.5) years; 11 108 (19%) had cardiovascular disease, and 1974 (3%) had chronic kidney disease. Use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a reduced risk of serious renal events (2.6 events per 1000 person years versus 6.2 events per 1000 person years; hazard ratio 0.42 (95% confidence interval 0.34 to 0.53); absolute difference −3.6 (–4.4 to −2.8) events per 1000 person years). In secondary outcome analyses, the hazard ratio for use of SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors was 0.32 (0.22 to 0.47) for renal replacement therapy, 0.41 (0.32 to 0.52) for hospital admission for renal events, and 0.77 (0.26 to 2.23) for death from renal causes. In sensitivity analyses in each of the Swedish and Danish parts of the cohort, the model was further adjusted for glycated haemoglobin and estimated glomerular filtration rate (Sweden and Denmark) and for blood pressure, body mass index, and smoking (Sweden only); in these analyses, the hazard ratio moved from 0.41 (0.26 to 0.66) to 0.50 (0.31 to 0.81) in Sweden and from 0.42 (0.32 to 0.56) to 0.55 (0.41 to 0.74) in Denmark.ConclusionsIn this analysis using nationwide data from three countries, use of SGLT2 inhibitors, compared with dipeptidyl peptidase-4 inhibitors, was associated with a significantly reduced risk of serious renal events.

Download Full-text

Use of incretin-based drugs and risk of cholangiocarcinoma: Scandinavian cohort study

Diabetologia ◽

10.1007/s00125-021-05508-1 ◽

2021 ◽

Author(s):

Peter Ueda ◽

Viktor Wintzell ◽

Mads Melbye ◽

Björn Eliasson ◽

Ann-Marie Svensson ◽

...

Keyword(s):

Incidence Rate ◽

Cox Regression ◽

Absolute Rate ◽

Dipeptidyl Peptidase 4 ◽

Rate Difference ◽

Receptor Agonists ◽

Dpp4 Inhibitors ◽

Increased Risk ◽

Increase In Risk

Abstract Aims/hypothesis Concerns have been raised regarding a potential association of use of the incretin-based drugs dipeptidyl peptidase 4 (DPP4) inhibitors and glucagon-like peptide-1 (GLP-1)-receptor agonists with risk of cholangiocarcinoma. We examined this association in nationwide data from three countries. Methods We used data from nationwide registers in Sweden, Denmark and Norway, 2007–2018, to conduct two cohort studies, one for DPP4 inhibitors and one for GLP-1-receptor agonists, to investigate the risk of incident cholangiocarcinoma compared with an active-comparator drug class (sulfonylureas). The cohorts included patients initiating treatment episodes with DPP4 inhibitors vs sulfonylureas, and GLP-1-receptor agonists vs sulfonylureas. We used Cox regression models, adjusted for potential confounders, to estimate hazard ratios from day 366 after treatment initiation to account for cancer latency. Results The main analyses of DPP4 inhibitors included 1,414,144 person-years of follow-up from 222,577 patients receiving DPP4 inhibitors (median [IQR] follow-up time, 4.5 [2.6–7.0] years) and 123,908 patients receiving sulfonylureas (median [IQR] follow-up time, 5.1 [2.9–7.8] years) during which 350 cholangiocarcinoma events occurred. Use of DPP4 inhibitors, compared with sulfonylureas, was not associated with a statistically significant increase in risk of cholangiocarcinoma (incidence rate 26 vs 23 per 100,000 person-years; adjusted HR, 1.15 [95% CI 0.90, 1.46]; absolute rate difference 3 [95% CI -3, 10] events per 100,000 person-years). The main analyses of GLP-1-receptor agonists included 1,036,587 person-years of follow-up from 96,813 patients receiving GLP-1-receptor agonists (median [IQR] follow-up time, 4.4 [2.4–6.9] years) and 142,578 patients receiving sulfonylureas (median [IQR] follow-up time, 5.5 [3.2–8.1] years) during which 249 cholangiocarcinoma events occurred. Use of GLP-1-receptor agonists was not associated with a statistically significant increase in risk of cholangiocarcinoma (incidence rate 26 vs 23 per 100,000 person-years; adjusted HR, 1.25 [95% CI 0.89, 1.76]; absolute rate difference 3 [95% CI -5, 13] events per 100,000 patient-years). Conclusions/interpretation In this analysis using nationwide data from three countries, use of DPP4 inhibitors and GLP-1-receptor agonists, compared with sulfonylureas, was not associated with a significantly increased risk of cholangiocarcinoma. Graphical abstract

Download Full-text

Impact of Intracoronary Optical Coherence Tomography in Routine Clinical Practice: A Contemporary Cohort Study

Cardiovascular Revascularization Medicine ◽

10.1016/j.carrev.2021.07.024 ◽

2021 ◽

Author(s):

Jonas D. Häner ◽

Benjamin Duband ◽

Yasushi Ueki ◽

Tatsuhiko Otsuka ◽

Nicolas Combaret ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Cohort Study ◽

Clinical Practice ◽

Routine Clinical Practice ◽

Optical Coherence

Download Full-text

Comparative Effectiveness of SGLT2i Versus DPP4i on Cardiovascular, Kidney and Hyperkalemia Outcomes in Individuals from Routine Clinical Practice: Observational Cohort Study

SSRN Electronic Journal ◽

10.2139/ssrn.3947641 ◽

2021 ◽

Author(s):

Edouard Fu ◽

Marco Trevisan ◽

Vivekananda Lanka ◽

Catherine M. Clase ◽

Yang Xu ◽

...

Keyword(s):

Cohort Study ◽

Clinical Practice ◽

Comparative Effectiveness ◽

Observational Cohort Study ◽

Routine Clinical Practice ◽

Observational Cohort

Download Full-text

Impact of different hemodiafiltration solutions on ionemia in long-term CRRT

The International Journal of Artificial Organs ◽

10.1177/03913988211043203 ◽

2021 ◽

pp. 039139882110432

Author(s):

Federico Nalesso ◽

Francesco Garzotto ◽

Leda Cattarin ◽

Georgie Innico ◽

Laura Gobbi ◽

...

Keyword(s):

Clinical Practice ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Balance Control ◽

Kidney Injury ◽

Critical Issue ◽

University Hospital ◽

Electrolyte Balance ◽

Standard Clinical Practice ◽

The Impact

Critical patients with Acute Kidney Injury (AKI) requiring renal replacement therapy are in most cases eligible only for continuous modalities where the electrolyte balance control is a critical issue. The standard solutions used for hemodiafiltration, containing potassium at 2 mmol/L and no phosphorus, determines during the extended renal replacement therapy hypokalemia and hypophosphatemia. Therefore, solutions containing potassium and phosphate in physiological concentrations were formulated to avoid electrolyte imbalances and reduce ion alterations in prolonged treatments, these solutions are not routinely used in the standard clinical practice. To avoid electrolyte imbalances, we have first introduced in our practice two different solutions and then we have retrospectively analyzed the electrolyte balance upon these two solutions in order to identity the impact of these solutions on potassium and phosphate according to our clinical practice. We retrospectively analyzed 96 patients treated with Continuous Renal Replacement Therapy (CRRT) in the intensive care units (ICU) at Padua’s University Hospital to evaluate the role on electrolyte balance of Phoxilium® and Prismasol 2® that differ in their composition and the need for electrolytes infusions. In the Phoxilium group the frequency of hypokalemia, hypophosphatemia, and the need of potassium and phosphate replacement were significantly reduced resulting in a reduction in complications, workload, and clinical risk associated with infusions of electrolytes. Our data demonstrated that the use of these two different hemodiafiltration solutions can reduce the occurrence of hypokalemia and hypophosphatemia during CRRT performing personalized treatments without the use of potassium and phosphate infusions.

Download Full-text

OP0056 Can We Replace Temporal Artery Biopsy with Cranial Ultrasound for the Diagnosis of GIANT Cell Arteritis? A Retrospective Cohort Study of the Diagnostic Utility of Ultrasound in Routine Clinical Practice: Table 1.

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-eular.4734 ◽

2014 ◽

Vol 73 (Suppl 2) ◽

pp. 82.1-82 ◽

Cited By ~ 3

Author(s):

A. Croft ◽

N. Thompson ◽

M. Duddy ◽

F. Khattak ◽

S. Mollan ◽

...

Keyword(s):

Cohort Study ◽

Clinical Practice ◽

Giant Cell Arteritis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Temporal Artery ◽

Routine Clinical Practice ◽

Diagnostic Utility ◽

Temporal Artery Biopsy ◽

Cranial Ultrasound

Download Full-text

Postoperative acute kidney injury requiring continuous renal replacement therapy and outcomes after coronary artery bypass grafting: a nationwide cohort study

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01704-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tak Kyu Oh ◽

In-Ae Song

Keyword(s):

Cohort Study ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Cox Regression ◽

Artery Bypass ◽

Kidney Injury ◽

Population Based ◽

Bypass Grafting ◽

All Cause Mortality ◽

Postoperative Aki

Abstract Background Previous studies reported that patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) after cardiac surgery were at a higher risk of postoperative mortality. However, the impact of AKI and CRRT on long-term mortality has not yet been identified. Therefore, we investigated whether postoperative AKI requiring CRRT was associated with one-year all-cause mortality after coronary artery bypass grafting (CABG). Methods For this population-based cohort study, we analyzed data from the National Health Insurance Service database in South Korea. The cohort included all adult patients diagnosed with ischemic heart disease who underwent isolated CABG between January 2012 and December 2017. Results A total of 15,115 patients were included in the analysis, and 214 patients (1.4%) required CRRT for AKI after CABG during hospitalization. They received CRRT at 3.1 ± 8.5 days after CABG, for 3.1 ± 7.8 days. On multivariable Cox regression, the risk of 1-year all-cause mortality in patients who underwent CRRT was 7.69-fold higher. Additionally, on multivariable Cox regression, the 30-day and 90-day mortality after CABG in patients who underwent CRRT were 18.20-fold and 20.21-fold higher than the normal value, respectively. Newly diagnosed chronic kidney disease (CKD) requiring renal replacement therapy (RRT) 1 year after CABG in patients who underwent CRRT was 2.50-fold higher. In the generalized log-linear Poisson model, the length of hospital stay (LOS) in patients who underwent CRRT was 5% longer. Conclusions This population-based cohort study showed that postoperative AKI requiring CRRT was associated with a higher 1-year all-cause mortality after CABG. Furthermore, it was associated with a higher rate of 30-day and 90-day mortality, longer LOS, and higher rate of CKD requiring RRT 1 year after CABG. Our results suggest that CRRT-associated AKI after CABG may be associated with an increased risk of mortality; hence, there should be interventions in these patients after hospital discharge.

Download Full-text