Research Papers:

Dipeptidyl peptidase 4 inhibitor use is associated with a lower risk of incident acute kidney injury in patients with diabetes

Chia-Ter Chao, Jui Wang, Hon-Yen Wu, Kuo-Liong Chien and Kuan-Yu Hung _

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Oncotarget. 2017; 8:53028-53040. https://doi.org/10.18632/oncotarget.18081

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Chia-Ter Chao1,2,*, Jui Wang3,*, Hon-Yen Wu2,3,4,5, Kuo-Liong Chien3 and Kuan-Yu Hung2,6

1Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan

2Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan

3Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan

4Department of Internal Medicine, Far-Eastern Memorial Hospital, New Taipei City, Taiwan

5Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

6Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan

*These authors contributed equally to this work

Correspondence to:

Kuan-Yu Hung, email: kyhung@ntu.edu.tw

Keywords: acute kidney injury, dialysis-requiring acute kidney injury, chronic kidney disease, diabetes mellitus, dipeptidyl peptidase 4 inhibitor

Received: April 07, 2017     Accepted: May 10, 2017     Published: May 23, 2017


Objectives: Dipeptidyl peptidase 4 inhibitor (DPP4i) use potentially slows the progression of diabetic kidney disease, but its effects on the risk of acute kidney injury (AKI) are unclear. We aimed to assess the association between DPP4i use and incident AKI episodes from a nationally representative cohort in Taiwan.

Materials and Methods: All patients newly diagnosed with diabetes mellitus (DM) between 2008, when DPP4i use was first approved in Taiwan, and mid-2013 were enrolled. Propensity score-matched diabetic DPP4i users, who received DPP4i for at least 90 days, and nonusers were selected. The primary and secondary outcomes were incident AKI and dialysis-requiring AKI during follow-up. Cox proportional hazard analyses were performed to examine the effect of DPP4i on the risk of AKI.

Results: We enrolled 923,936 diabetic patients; of these, 83,638 DPP4i users (75.7% sitagliptin, 14.6% vildagliptin, and 9.7% saxagliptin) were propensity score-matched to 83,638 non-users. After an average 3.6-year follow-up, 1.56% and 0.35% of DPP4i users and 2.53% and 0.56% of non-users developed incident AKI and dialysis-requiring AKI, respectively. DPP4i use was significantly associated with lower risk of incident AKI (hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.53–0.61) and risk of dialysis-requiring AKI (HR 0.57, 95% CI 0.49–0.66). The risk reduction was consistent regardless of DPP4i type, the presence of chronic kidney disease, the previous acute kidney injury, and age.

Conclusions: DPP4i use is associated with reduced risk of mild and severe forms of AKI among patients with incident DM. DPP4i may be an important class of anti-glycaemic agent with reno-protective effects.

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