10.6084/m9.figshare.4629856.v1
Walker S.R.
Walker
S.R.
Komenda P.
Komenda
P.
Khojah S.
Khojah
S.
Al-Tuwaijri W.
Al-Tuwaijri
W.
MacDonald K.
MacDonald
K.
Hiebert B.
Hiebert
B.
Tangri N.
Tangri
N.
Nadurak S.W.D.
Nadurak
S.W.D.
Ferguson T.W.
Ferguson
T.W.
Rigatto C.
Rigatto
C.
Supplementary Material for: Dipeptidyl Peptidase-4 Inhibitors in Chronic Kidney Disease: A Systematic Review of Randomized Clinical Trials
Karger Publishers
2017
Chronic kidney disease
Dipeptidyl peptidase-4 inhibitors
Type 2 diabetes mellitus
2017-02-08 13:27:01
Dataset
https://karger.figshare.com/articles/dataset/Supplementary_Material_for_Dipeptidyl_Peptidase-4_Inhibitors_in_Chronic_Kidney_Disease_A_Systematic_Review_of_Randomized_Clinical_Trials/4629856
<p><b><i>Background:</i></b> Chronic kidney disease (CKD) is common in
patients with type 2 diabetes mellitus (T2DM) and limits therapeutic
options. Dipeptidyl peptidase-4 (DPP-4) inhibitors represent a novel
class of oral glucose-lowering agents and are known to be safe and
effective in the general population. <b><i>Methods:</i></b> We searched
Cochrane, EMBASE, and PubMed from the time of their inception until
March 2015. We included randomized controlled trials analyzing the
efficacy (change in hemoglobin A1C [HbA1C]) and safety of DPP-4 agents
in individuals with reduced kidney function (estimated glomerular
filtration rate <60 mL/min/1.73 m<sup>2</sup>). We extracted study
characteristics, participants' baseline characteristics, and safety
outcomes from eligible studies. We performed a random effects
meta-analysis to summarize the change in HbA1C and the relative risk of
cardiovascular events in patients with T2DM and CKD. We also collected
data on hypoglycemia, other serious adverse events, and mortality. <b><i>Results:</i></b>
We reviewed 12 studies with 4,403 patients with CKD and 239 on
dialysis, finding a mean weighted decline in HbA1C of -0.48 (95% CI
-0.61 to -0.35) with DPP-4 inhibitor therapy compared to placebo. DPP-4
inhibitors did not result in any additional adverse events, hypoglycemic
episodes, or increased mortality. Restricting to studies with low risk
of bias did not alter these findings. <b><i>Conclusions:</i></b> DPP-4
inhibitors can lower HbA1C without increasing the risk of cardiovascular
or other major adverse events in patients with CKD. Few studies
reported critical adverse events such as heart failure and
hypersensitivity. If compared with other oral antiglycemic drugs, the
effect of DPP-4 inhibitors is limited; however, their low risk of
hypoglycemia may favor their use in patients with CKD. <b><i>Summary:</i></b>
This systematic review of DPP-4 inhibitors in CKD suggests that they
reduce HbA1C by about 0.5%. Furthermore, there was not any increase in
the risk for significant adverse events. More research is needed to
determine the safety and efficacy of DPP-4 inhibitors in CKD.</p>