with recent hospitalizations, Black race, Hispanic ethnicity, and vascular disease.Discontinuation of both agents was associated with death and cardiovascular events. Background Little is known about the association of discontinuation of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RA) with outcomes in patients with CKD. Methods We identified adults with CKD stages 3–4 from 2005 to 2022 in the Veterans Affairs health care system. Individuals with an incident prescription for SGLT2 inhibitors or GLP-1 RAs were included, with the first fill date considered the index date. Factors associated with time to first treatment discontinuation, defined as an interruption in SGLT2 inhibitor or GLP-1 RA prescription for ≥90 days, were studied using Cox proportional hazards regression models. Associations of discontinuation 90–179 and ≥180 days with death, myocardial infarction, coronary revascularization, hospitalization for heart failure, and ischemic stroke were assessed using Cox proportional hazards regression. Results Of 96,345 individuals who received an SGLT2 inhibitor and 60,020 who received a GLP-1 RA, at least one discontinuation occurred in 35,953 (37%) of SGLT2 inhibitor users and 28,407 (47%) of GLP-1 RA users. SGLT2 inhibitor users were 24% Black, 71% White, 71% age ≥70, and 84% with CKD stage 3a. GLP-1 RA users were 20% Black, 75% White, 63% age ≥70, and 81% with CKD stage 3a. Black race, Hispanic ethnicity, cerebrovascular disease, peripheral vascular disease, and ischemic heart disease were associated with discontinuation of both drug classes. Female sex and more advanced CKD stage were also associated with SGLT2 inhibitor discontinuation. SGLT2 inhibitor discontinuation ≥180 days was associated with death (adjusted hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.58 to 1.77) and heart failure hospitalization (adjusted HR, 1.26; 95% CI, 1.13 to 1.40). GLP-1 RA discontinuation ≥180 days was associated with death (adjusted HR, 1.97; 95% CI, 1.87 to 2.07), myocardial infarction (adjusted HR, 1.23; 95% CI, 1.11 to 1.36), heart failure hospitalization (adjusted HR, 1.48; 95% CI, 1.33 to 1.64), and ischemic stroke (adjusted HR, 1.24; 95% CI, 1.14 to 1.35). Conclusions SGLT2 inhibitor and GLP-1 RA discontinuation was common and associated with harmful outcomes in adults with CKD....

中文翻译：

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钠-葡萄糖协同转运蛋白-2 抑制剂和胰高血糖素样肽-1 受体激动剂在 CKD 患者中停药


最近住院、黑人、西班牙裔和血管疾病。两种药物的停药都与死亡和心血管事件相关。背景 关于停用钠-葡萄糖协同转运蛋白-2 （SGLT2） 抑制剂和胰高血糖素样肽-1 受体激动剂 （GLP-1 RA） 与 CKD 患者结局的关系知之甚少。方法 我们在退伍军人事务医疗保健系统中确定了 2005 年至 2022 年患有 3-4 期 CKD 的成年人。纳入了有 SGLT2 抑制剂或 GLP-1 RAs 新处方的个体，首次填写日期被视为索引日期。使用 Cox 比例风险回归模型研究了与首次治疗停止时间相关的因素，定义为 SGLT2 抑制剂或 GLP-1 RA 处方中断 ≥90 天。使用 Cox 比例风险回归评估停药 90-179 和 ≥180 天与死亡、心肌梗死、冠状动脉血运重建、心力衰竭住院和缺血性卒中的相关性。结果 在 96,345 名接受 SGLT2 抑制剂治疗的个体和 60,020 名接受 GLP-1 RA 的个体中，35,953 名 （37%） 的 SGLT2 抑制剂使用者和 28,407 名 （47%） 的 GLP-1 RA 使用者中至少发生了一次停药。SGLT2 抑制剂使用者为 24% 黑人，71% 白人，71% 年龄≥ 70%，84% 为 CKD 3a 期。GLP-1 RA 使用者为 20% 黑人，75% 白人，63% ≥ 70 岁，81% 为 CKD 3a 期。黑人、西班牙裔、脑血管疾病、外周血管疾病和缺血性心脏病与这两类药物的停药有关。女性和更晚期的 CKD 分期也与 SGLT2 抑制剂停药有关。 停用 SGLT2 抑制剂 ≥180 天与死亡 （校正风险比 [HR]，1.67;95% 置信区间 [CI]，1.58 至 1.77）和心力衰竭住院 （校正 HR，1.26;95% CI，1.13 至 1.40）相关。停用 GLP-1 RA ≥180 天与死亡 （校正 HR，1.97;95% CI，1.87 至 2.07）、心肌梗死 （校正 HR，1.23;95% CI，1.11 至 1.36）、心力衰竭住院 （校正 HR，1.48;95% CI，1.33 至 1.64）和缺血性卒中 （校正 HR，1.24;95% CI，1.14 至 1.35）相关。结论 SGLT2 抑制剂和 GLP-1 RA 停药在成人 CKD 患者中很常见，并且与有害结局相关。