sábado, 28 de enero de 2012

Comparative effectiveness of incident oral antidi... [Kidney Int. 2012] - PubMed - NCBI

Comparative effectiveness of incident oral antidi... [Kidney Int. 2012] - PubMed - NCBI

News on Early Treatments for Type 2 Diabetes
A new original research report from AHRQ’s Effective Health Care Program published in Kidney International shows that compared with diabetes patients using the metformin class of drugs, patients using the sulfonylurea class have an increased risk of experiencing a decline in kidney function, end-stage renal disease, or death. Patients who were started on sulfonylureas had a 20 percent increased risk of a persistent decline in kidney function rate of 25 percent or more, or a diagnosis of end-stage kidney disease compared to those started on metformin. Because of these new findings, the current recommendation to limit the use of metformin alone in patients with mild to moderate kidney disease should be re-examined to avoid or delay changes in medical therapy. Select to access the abstract for “Comparative Effectiveness of Incident Oral Antidiabetic Drugs on Kidney Function” on PubMed.®

Kidney Int. 2012 Jan 18. doi: 10.1038/ki.2011.444. [Epub ahead of print]

Comparative effectiveness of incident oral antidiabetic drugs on kidney function.

Hung AM, Roumie CL, Greevy RA, Liu X, Grijalva CG, Murff HJ, Ikizler TA, Griffin MR.

Source

1] VA Tennessee Valley, Clinical Science Research and Development, Geriatric Research Education Clinical Center (GRECC), Department of Medicine, Nashville, Tennessee, USA [2] Department of Medicine, Vanderbilt University, Nashville, Tennessee, USA [3] Division of Nephrology, Vanderbilt University, Nashville, Tennessee, USA.

Abstract

Diabetes is a major cause of chronic kidney disease, and oral antidiabetic drugs are the mainstay of therapy for most patients with Type 2 diabetes. Here we evaluated their role on renal outcomes by using a national Veterans Administration database to assemble a retrospective cohort of 93,577 diabetic patients who filled an incident oral antidiabetic drug prescription for metformin, sulfonylurea, or rosiglitazone, and had an estimated glomerular filtration rate (eGFR) of 60 ml/min or better. The primary composite outcome was a persistent decline in eGFR from baseline of 25% or more (eGFR event) or a diagnosis of end-stage renal disease (ESRD). The secondary outcome was an eGFR event, ESRD, or death. Sensitivity analyses included using a more stringent definition of the eGFR event requiring an eGFR <60 ml/min per 1.73 m(2) in addition to the 25% or more decline; controlling for baseline proteinuria thereby restricting data to 15,065 patients; and not requiring persistent treatment with the initial oral antidiabetic drug. Compared to patients using metformin, sulfonylurea users had an increased risk for both the primary and the secondary outcome, each with an adjusted hazard ratio of 1.20. Results of sensitivity analyses were consistent with the main findings. The risk associated with rosiglitazone was similar to metformin for both outcomes. Thus, compared to metformin, oral antidiabetic drug treatment with sulfonylureas increased the risk of a decline in eGFR, ESRD, or death.Kidney International advance online publication, 18 January 2012; doi:10.1038/ki.2011.444.