Diabetes Treatment in Patients with Renal Disease—How Many Are Receiving Contraindicated Drugs?

Abstract

Objective: To estimate the CKD (GFR <60 ml/min and/or UACR ≥ 30 mg/g) prevalence among T2DM patients and evaluate the use of antidiabetic drugs based on renal function. Methods: Retrospective, cross-sectional study, analyzing data from the Spanish electronic records database “Information System for the Development of Research in Primary Care, SIDIAP”, from Jan, 2015 to Dec, 2016. The use of antidiabetic drugs for each stage of chronic renal failure (CRF; GFR<60 mL/min) was evaluated in patients with available records of GFR. Furthermore, the adjusted RR for 5 events (global mortality, cardiovascular mortality, renal failure treated with dialysis or transplantation, acute renal failure and progression of kidney disease) according to KDIGO 2012 guidelines were assessed in those patients with available registers of both UACR and GFR. Results: From the overall T2DM study population (373,185), 33% (122,296) had CKD, of those, 48% were women, with a mean age of 76 years, a mean T2DM duration of 11 years and a mean HbA1c value of 7.2% (SD 1.37). A total of 336,198 patients (90%) had GFR data, and 94,240 (28%) had CRF. Among those with GFR 30 to < 45 mL/min (29,038; 8.9%), metformin was the most frequently used drug (49.6%), followed by insulin (33.5%), DPP-4i (21%) and sulfonylureas (15.9%). Among patients with GFR < 30 mL/min (13,262, 4%), insulin was the most used drug (50%), followed by DPP-4i (23%), metformin (16%), repaglinide (16%) and sulfonylureas (6.1%). The KDIGO 5 event-adjusted RR distribution among the 236,830 patients with available values of both UACR and GFR was: Low: 60.9%; Mild: 21.6%, High: 9.8% and Very high: 7.7%. Conclusion: CKD is a very frequent comorbidity among T2DM patients. The use of antidiabetic drugs is more complex in these patients because many people with kidney disease are often elderly, and have long lasting disease and significant comorbidities. A relevant number of T2DM patients are still treated with contraindicated antidiabetic drugs regarding their renal function. Disclosure M. Mata-Cases: None. J. Franch-Nadal: None. J. Real: None. K. Ferreira de Campos: Employee; Self; Merck Sharp & Dohme Corp. M. Cedenilla: Employee; Self; Merck Sharp & Dohme Corp. A. Gómez: Employee; Self; Merck Sharp & Dohme Corp. D. Mauricio: Advisory Panel; Self; AstraZeneca. Research Support; Self; AstraZeneca. Speaker's Bureau; Self; Eli Lilly and Company, GlaxoSmithKline plc.. Research Support; Self; GlaxoSmithKline plc.. Advisory Panel; Self; Janssen-Cilag Pty Limited. Speaker's Bureau; Self; Merck Sharp & Dohme Corp.. Board Member; Self; Merck Sharp & Dohme Corp.. Research Support; Self; Merck Sharp & Dohme Corp.. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Sanofi. Board Member; Self; Sanofi. Speaker's Bureau; Self; Sanofi. Research Support; Self; Sanofi.