123-OR: SGLT2 Inhibitors Are Associated with Kidney Benefits at All Degrees of Proteinuria—A Cohort Study
Bibliographic record
Abstract
Background: The kidney benefits of sodium-glucose lowering co-transporter 2 inhibitors (SGLT2i) in adults with non-severe albuminuria, under-represented in SGLT2i trials, are not well established. Objective: We performed a retrospective cohort study to examine the effectiveness of SGLT2i compared to dipeptidyl peptidase-4 inhibitors (DPP4i), in Alberta, Canada. Methods: Using administrative data, we derived a cohort of SGLT2i new-users (2014-2018) with diabetes and eGFR ≥ 30 mL/min/1.73 m2. New SGLT2i users were matched 1:2 to DPP4i users by CKD stage, albuminuria, and diabetes therapy, and by time-conditional propensity-score (age, sex, A1c, etc.). Non-severe albuminuria was defined as a urine albumin to creatinine ratio ≤ 30 mg/mmol. Linear and Poisson regression models were used to determine the association of SGLT2i use with each outcome: eGFR decline (acute [≤ 60 days] and total), adverse kidney events, and all-cause mortality. An adverse kidney event was defined as sustained 40% loss of eGFR, initiation of kidney replacement therapy, or death from kidney causes. Results: SGLT2i users (n=19,238) had a mean age of 57.9 years (male 59.1%) and non-severe albuminuria in 94.4%. Mean eGFR was 91.7 mL/min/1.73m2, and 62.0% were dispensed ACE inhibitor or ARB. Median follow-up was 1.58 years (IQR 0.91-2.49). The acute change in eGFR was -2.79 (SGLT2i) vs -1.43 (DPP4i), for a difference of -1.36 (95% CI -1.74-[-0.98], p < 0.001). After day 60, SGLT2i use was associated with 0.83 (0.66-1.01, p < 0.001) less annual eGFR loss than in DPP4i users. SGLT2i use was associated with fewer adverse kidney events (IRR 0.58 [0.47-0.71], p < 0.001), driven mostly by less sustained loss of eGFR, but was not associated with all-cause mortality (IR 0.82 [0.66-1.01], p = 0.06). Similar findings were observed in those with non-severe albuminuria. Interpretation: SGLT2i may prevent eGFR decline and reduce the risk of adverse kidney events in adults with diabetes, regardless of baseline albuminuria status. Disclosure K.K.Fujita: None. F.Ye: None. D.Collister: None. S.Klarenbach: Research Support; Bayer Inc., Allergan, GlaxoSmithKline plc., CSL Behring, Lundbeck, University Hospital Foundation (University of Alberta), Purdue Canada. D.J.T.Campbell: None. D.Chew: None. A.E.Quinn: None. P.E.Ronksley: None. D.Lau: None.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".