LT2i discontinuation in patients with CKD may limit the cardiokidney benefits of SGLT2i in real-world practice. Background The effect of sodium-glucose co-transporter-2 inhibitors (SGLT2i) on cardiovascular disease and CKD may be limited if discontinued in persons with CKD. We sought to determine whether CKD at SGLT2i initiation was associated with subsequent discontinuation. Methods This cohort study used electronic health record data of patients who initiated SGLT2i in the Veterans Health Administration from January 2017 through December 2021. The primary exposure was eGFR category at the time of SGLT2i initiation. The risk of SGLT2i discontinuation, defined by a provider order or expiration of an SGLT2i prescription without resumption in the following 180 days, was estimated using proportional hazards models with inverse probability weights for censoring due to death. Analyses were stratified by year of SGLT2i initiation. Results Among the 222,772 patients initiating an SGLT2i during the study period, the median age was 68 (interquartile range, 60–73) years, 95% were male, and median (interquartile range) eGFR was 73 (58–89) ml/min per 1.73 m2. Median follow-up was 1.6 years; 32% experienced SGLT2i discontinuation. Cumulative risk of discontinuation at 1 year was 21%–27% across calendar years; approximately 41% of these discontinuations occurred within the first 3 months. There was a graded association between lower baseline eGFR and greater risk of discontinuation; this association attenuated across calendar years. Those initiating an SGLT2i in 2017 with baseline eGFR of 45–59 and 30–44 had 1.34- (95% confidence interval [CI], 1.21 to 1.49) and 2.04-fold (95% CI, 1.58 to 2.63) risks of discontinuation, respectively, compared with those with eGFR ≥60 ml/min per 1.73 m2. These hazard ratios reduced to 1.05 (95% CI, 1.02 to 1.10) and 1.20 (95% CI, 1.14 to 1.26), respectively, in those initiated in 2021. Conclusions A substantial proportion of patients experience SGLT2i discontinuation within a year of initiation. Those with lower eGFR had higher discontinuation rates; however, this trend attenuated over time. Additional studies identifying and addressing factors leading to discontinuation are needed to fully realize the benefits of SGLT2i....

中文翻译：

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美国退伍军人肾功能与钠-葡萄糖协同转运蛋白 2 抑制剂停用的关系


CKD 患者停用 LT2i 可能会限制 SGLT2i 在实际实践中的心脏肾脏益处。背景 如果在 CKD 患者中停用钠-葡萄糖协同转运蛋白 2 抑制剂 （SGLT2i） 对心血管疾病和 CKD 的影响可能会受到限制。我们试图确定 SGLT2i 开始时的 CKD 是否与随后的停药相关。方法 该队列研究使用了 2017 年 1 月至 2021 年 12 月在退伍军人健康管理局启动 SGLT2i 的患者的电子健康记录数据。主要暴露是 SGLT2i 开始时的 eGFR 类别。SGLT2i 停药的风险（定义为提供者命令或 SGLT2i 处方过期在接下来的 180 天内未恢复）使用比例风险模型进行估计，该模型具有因死亡而删失的逆概率权重。分析按 SGLT2i 起始年份分层。结果 在研究期间开始 SGLT2i 的 222,772 名患者中，中位年龄为 68 岁（四分位距，60-73 岁），95% 为男性，中位（四分位距）eGFR 为 73 （58-89） ml/min/1.73 m2。中位随访时间为 1.6 年;32% 的患者出现 SGLT2i 停药。跨日历年，1 年时停药的累积风险为 21%-27%;这些停药中约有 41% 发生在前 3 个月内。较低的基线 eGFR 与较大的停药风险之间存在分级关联;这种关联在日历年中减弱。与 eGFR ≥60 ml/min /1 的患者相比，2017 年开始基线 eGFR 为 45-59 和 30-44 的患者停药风险分别为 1.34 倍（95% 置信区间 [CI]，1.21 至 1.49）和 2.04 倍（95% CI，1.58 至 2.63）。73 平方米。在 2021 年启动的试验中，这些风险比分别降至 1.05（95% CI，1.02 至 1.10）和 1.20（95% CI，1.14 至 1.26）。结论 很大一部分患者在开始后一年内经历了 SGLT2i 停药。eGFR 较低的患者停药率较高;然而，这种趋势随着时间的推移而减弱。需要进行更多研究来确定和解决导致停药的因素，以充分实现 SGLT2i 的好处。