Comparison of renal prognosis between dipeptidyl peptidase-4 inhibitor users and non-users

Aim: To evaluate the renal prognosis of dipeptidyl peptidase-4 inhibitor (DPP-4i) users and non-users using real-world Asian data. Methods: Using databases from DeSC Healthcare, Inc., patients aged 30 years or older who used antidiabetic drugs from 2014 to 2021 were identified. Propensity score matching analyses were used to compare renal prognosis between DPP-4i users and non-users. The primary outcomes were estimated glomerular filtration rate (eGFR) decline and end-stage kidney disease (ESKD) development in the eGFR of 45 mL/min/1.73m² or higher and eGFR of less than 45 mL/min/1.73m² groups, respectively. Results: In total, 65 375 and 9866 patients were identified in the eGFR of 45 mL/min/1.73m² or higher and eGFR of less than 45 mL/min/1.73m² groups, respectively. In the eGFR of 45 mL/min/1.73m² or higher group, propensity score matching created 16 002 pairs. A significant difference was observed in the primary outcome of eGFR decline between DPP-4i users and non-users at 2 years (−2.31 vs. −2.56 mL/min/1.73m²: difference, 0.25 mL/min/1.73m²; 95% confidence interval [CI], 0.06-0.44) and 3 years (−2.75 vs. −3.41 mL/min/1.73m²: difference, 0.66 mL/min/1.73m²; 95% CI, 0.39-0.93). In the eGFR less than 45 mL/min/1.73m² group, propensity score matching created 2086 pairs. After a mean of 2.2 years of observation, ESKD development was 1.15% and 2.30% in users and non-users, respectively, and Kaplan–Meier analysis revealed a significant difference (log rank P =.005). Conclusions: This retrospective real-world study revealed that patients using DPP-4is had a better renal prognosis than those not using DPP-4is.