The effect of empagliflozin on renal outcomes compared to sitagliptin with type 2 diabetes: target trial emulation using electronic medical records

초록

Introduction The renal effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors in diverse populations remain under investigation. While randomized controlled trials have shown renoprotective effects of SGLT2 inhibitors, their impact in routine clinical settings and specific populations such as Koreans requires further evaluation. Aim This study aimed to evaluate the impact of empagliflozin compared to sitagliptin on renal function and related clinical outcomes in patients with type 2 diabetes (T2D) using a target trial emulation approach. Method We conducted a retrospective cohort study using electronic medical records from a Korean tertiary care hospital between 2018 and 2019. New users of empagliflozin or sitagliptin were identified and matched using propensity scores to control for confounding factors. Primary outcomes included changes in estimated glomerular filtration rate (eGFR) and other renal function markers over time. Secondary outcomes included acute kidney injury, albuminuria, and composite renal events, as well as other clinical parameters. A modified intention-to-treat analysis was performed, with follow-up up to 13 months. Results After matching, 219 T2D patients were identified in each group. Empagliflozin was associated with a slower decline in eGFR compared to sitagliptin (p < 0.05). Serum phosphorus levels increased more with empagliflozin (p < 0.05). Empagliflozin showed a non-significant trend toward lower risk of composite renal outcomes (hazard ratio [HR] 0.78; 95% confidence interval [CI], 0.50-1.22). Significant increases in weight loss (HR 2.95; 95% CI, 2.01-4.33) and urination frequency (HR 4.05; 95% CI, 1.14-14.34) were observed with empagliflozin. Serum uric acid levels decreased more in the empagliflozin group (p < 0.05). Conclusion This real-world study suggests that empagliflozin may offer renoprotective benefits compared to sitagliptin in T2D patients. However, the increased serum phosphorus levels warrant careful monitoring. These findings provide valuable insights for clinical decision-making in managing T2D patients at risk of renal complications.

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