T2DM: DPP-4 inhibitors tied to heart failure risk in comorbid CKD

  • Huang TL & al.
  • PLoS One
  • 21 May 2019

  • International Clinical Digest
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Takeaway

  • Dipeptidyl peptidase-4 inhibitors (DPP-4is) should be used with caution in patients with type 2 diabetes mellitus (T2DM) and comorbid chronic kidney disease (CKD) because of an increased risk for hospitalization for heart failure (hHF).

Why this matters

  • Although many studies have examined the relationship between DPP-4is and cardiovascular events, few have focused on comorbid CKD.

Study design

  • Study of 125,245 patients with T2DM receiving oral hypoglycemic agents; 37,641 (30.0%) had comorbid CKD.
  • Propensity-matched pairs were constructed for DPP-4i users vs nonusers with CKD (8213 pairs) and without CKD (12,313 pairs).
  • Major adverse cardiovascular events (MACE) included ischemic stroke, myocardial infarction, and cardiovascular death.
  • Funding: None disclosed.

Key results

  • Median follow-up: HF (CKD, 567 days; non-CKD, 611 days); MACE (CKD, 553 days; non-CKD, 600 days).
  • CKD: DPP-4is were tied to a higher rate of hHF (15.0 vs 9.9 events per 1000 patient-years), corresponding to 25% increased risk (HR=1.25; P=.0373).
    • No significant effect on MACE risk (P=.1443).
  • Non-CKD: DPP-4is were associated with a reduced MACE rate (9.8 vs 12.6 events per 1000 patient-years), corresponding to a 27% reduced risk (HR=0.73; P=.0007).
    • Effect driven by 32% reduced risk for ischemic stroke (7.4 vs 10.0 events per 1000 patient-years; HR=0.68; P=.0003).
    • No significant effect on hHF risk (P=.6314).

Limitations

  • Observational design, reliance on claims data; adherence unknown.