Effects of Dipeptidyl Peptidase-4 Inhibitors on Renal Outcomes in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis
- Authors
- Bae, Jae Hyun; Kim, Sunhee; Park, Eun-Gee; Kim, Sin Gon; Hahn, Seokyung; Kim, Nam Hoon
- Issue Date
- 3월-2019
- Publisher
- KOREAN ENDOCRINE SOC
- Keywords
- Albuminuria; Diabetes complications; Diabetes mellitus, type 2; Diabetic nephropathies; Dipeptidyl-peptidase IV inhibitors; Glomerular filtration rate; Kidney failure, chronic; Meta-analysis; Systematic review
- Citation
- ENDOCRINOLOGY AND METABOLISM, v.34, no.1, pp.80 - 92
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- ENDOCRINOLOGY AND METABOLISM
- Volume
- 34
- Number
- 1
- Start Page
- 80
- End Page
- 92
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/67133
- DOI
- 10.3803/EnM.2019.34.1.80
- ISSN
- 2093-596X
- Abstract
- Background: To investigate the effects of dipeptidyl peptidase-4 (DPP-4) inhibitors on renal outcomes in patients with type 2 diabetes. Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials (RCTs) of DPP-4 inhibitors from inception to September 2017. We selected eligible RCTs comparing DPP-4 inhibitors with placebo or other antidiabetic agents and reporting at least one renal outcome. A meta-analysis was conducted to calculate standardized mean differences, weighted mean differences (WMDs), relative risks (RRs), and 95% confidence intervals (CIs) for each renal outcome. Results: We included 23 RCTs with 19 publications involving 41,359 patients. Overall changes in urine albumin-to-creatinine ratio were comparable between DPP-4 inhibitors and controls (P=0.150). However, DPP-4 inhibitors were associated with significantly lower risk of incident microalbuminuria (RR, 0.89; 95% CI, 0.80 to 0.98; P=0.022) and macroalbuminuria (RR, 0.77; 95% CI, 0.61 to 0.97; P=0.027), as well as higher rates of regression of albuminuria (RR, 1.22; 95% CI, 1.10 to 1.35; P< 0.001) compared with controls. Although DPP-4 inhibitors were associated with small but significantly lower estimated glomerular filtration rate (WMD, -1.11 mL/min/1.73 m(2); 95% CI, -1.78 to -0.44; P=0.001), there was no difference in the risk of end-stage renal disease between two groups (RR, 0.93; 95% CI, 0.76 to 1.14; P=0.475). Conclusion: DPP-4 inhibitors had beneficial renal effects mainly by reducing the risk of development or progression of albuminuria compared with placebo or other antidiabetic agents.
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