BACKGROUND AND AIMS: The clinical landscape for the treatment of patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) is rapidly evolving. We aimed to characterize patients with CKD and T2D who initiated an SGLT2i or a GLP-1RA in a Danish real-world clinical care setting.
MATERIALS AND METHODS: We ascertained individual-level data on all biochemical laboratory tests performed in primary care or hospitals for the entire population of Denmark during 2012 to 2021, using linked healthcare databases. We identified individuals with both CKD and T2D by a combination of laboratory values, hospital diagnosis codes, and prescriptions for glucose-lowering drugs. CKD was defined as either an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 or a urinary albumin-to-creatinine ratio (UACR) ≥ 30 mg/g (using a second confirmed measurement within 90 to 540 days), or a CKD diagnosis code. Among these individuals, we assessed new users of SGLT2i and GLP-1RA, and examined their baseline characteristics, including their eGFR and UACR at drug initiation.
RESULTS: We identified 21,739 new users of SGLT2i and 18,929 new users of GLP-1RA. The two cohorts had remarkably similar age (median 68 years), diabetes duration (median 11 years), and time since first record of CKD (median 3 years). The SGLT2i cohort had slightly more heart failure and coronary heart disease than the GLP-1RA cohort (9% vs. 5% and 9% vs. 7%). Only 1% in both cohorts had no available eGFR measurement within the last year. SGLT2i initiators had a median (IQR) eGFR of 77 (57,97) with 29% at CKD stage 3 or higher, whereas GLP-1RA initiators had a lower median eGFR of 69 (50,96), with 39% at CKD stage 3 or higher. UACR was missing for 19% in both drug groups, and those with no available UACR tended to be older, had more comorbidity, lower eGFR and less intensive diabetes therapy. UACR levels were similar in the two cohorts: SGLT2i initiators, UACR median (IQR) =61 (24,179) with 57% at CKD UACR stage 2 or higher; GLP-1RA initiators, UACR median (IQR) =56 (22,165), with 55% at UACR stage 2 or higher. Poor glycemic control (HbA1c >8 % / 63.9 mmol/mol, missing in 2%) was frequent in both initiators of SGLT2i (53%) and GLP-1RA (58%), with median (IQR) HbA1c = of 65 (56,76) and 67 (58,79) mmol/mol, respectively, and many patients used insulin therapy (31% and 39%).
CONCLUSION: Using unique Danish healthcare data, we have established a cohort of patients with T2D and CKD applicable for clinical research. We observed that initiators of SGLT2i and GLP-1RA shared many similarities both with respect to their T2D and CKD. Defining CKD by a combination of eGFR and UACR values yielded a population with a high burden of albuminuria. Current eGFR and UACR values at time of reno-protective glucose-lowering drug initiation may not reflect conditions of when patients were first classified as having CKD in healthcare databases.
