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Original ArticlesDiabetes and the Kidney
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Higher-Dose Sitagliptin and the Risk of Congestive Heart Failure in Older Adults with CKD

Flory T. Muanda, Matthew A. Weir, Lavanya Bathini, Kristin K. Clemens, Vlado Perkovic, Manish M. Sood, Eric McArthur, Jessica M. Sontrop, Richard B. Kim and Amit X. Garg
CJASN December 2020, 15 (12) 1728-1739; DOI: https://doi.org/10.2215/CJN.08310520
Flory T. Muanda
1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada
2Department of Epidemiology and Biostatistics, Western University, London, Canada
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Matthew A. Weir
1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada
2Department of Epidemiology and Biostatistics, Western University, London, Canada
3Division of Nephrology, Department of Medicine, Western University, London, Canada
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Lavanya Bathini
1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada
3Division of Nephrology, Department of Medicine, Western University, London, Canada
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Kristin K. Clemens
1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada
4Division of Endocrinology and Metabolism, Department of Medicine, Western University, London, Canada
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  • ORCID record for Kristin K. Clemens
Vlado Perkovic
5The George Institute for Global Health, University of New South Wales, Sydney, Australia
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Manish M. Sood
1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada
6The Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, Ontario, Canada
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Eric McArthur
1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada
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Jessica M. Sontrop
3Division of Nephrology, Department of Medicine, Western University, London, Canada
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Richard B. Kim
7Division of Clinical Pharmacology, Department of Medicine, Western University, London, Ontario, Canada
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Amit X. Garg
1ICES, Kidney, Dialysis and Transplantation Research Program, Ontario, Canada
2Department of Epidemiology and Biostatistics, Western University, London, Canada
3Division of Nephrology, Department of Medicine, Western University, London, Canada
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Abstract

Background and objectives Sitagliptin, a dipeptidyl peptidase-4 inhibitor, is commonly prescribed to patients with type 2 diabetes. As this drug is primarily eliminated by the kidney, a reduced dose is recommended for patients with CKD. Some evidence suggests that sitagliptin is associated with a higher risk of congestive heart failure, particularly at higher doses. We compare the 1-year risk of death or hospitalization with congestive heart failure in patients with CKD newly prescribed sitagliptin at >50 versus ≤50 mg/d.

Design, setting, participants, & measurements This population-based cohort study included older adults (>66 years) with type 2 diabetes and an eGFR<45 ml/min per 1.73 m2 (but not receiving dialysis) who were newly prescribed sitagliptin between 2010 and 2017 in Ontario, Canada. We used inverse probability of treatment weighting on the basis of propensity scores to balance baseline characteristics. The primary composite outcome was death or hospitalization with congestive heart failure. Secondary outcomes included hospitalization with pancreatitis or hypoglycemia, all-cause hospitalization, and glycemic control. Weighted hazard ratios were obtained using Cox proportional hazards regression, and 95% confidence intervals were obtained using bootstrap variance estimators.

Results Of 9215 patients, 6518 started sitagliptin at >50 mg/d, and 2697 started sitagliptin at ≤50 mg/d. The 1-year risk of death or hospitalization with congestive heart failure did not differ significantly between groups (79 versus 126 events per 1000 person-years; weighted hazard ratio, 0.88; 95% confidence interval, 0.67 to 1.14); hospitalization with pancreatitis (weighted hazard ratio, 0.98; 95% confidence interval, 0.32 to 3.03) and hypoglycemia (weighted hazard ratio, 1.10; 95% confidence interval, 0.64 to 1.90) also did not differ significantly between groups. Patients starting sitagliptin at >50 mg/d had lower mean glycated hemoglobin concentrations (weighted between-group difference, −0.12%; 95% confidence interval, −0.19 to −0.06) and a lower risk of all-cause hospitalization (weighted hazard ratio, 0.81; 95% confidence interval, 0.66 to 0.98).

Conclusions The risk of death or congestive heart failure was not higher in older adults with CKD starting sitagliptin at >50 versus ≤50 mg/d.

Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2020_11_25_CJN08310520_final.mp3

  • sitagliptin
  • chronic kidney disease
  • dosage
  • toxicity
  • heart failure
  • Received May 26, 2020.
  • Accepted August 17, 2020.
  • Copyright © 2020 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 15 (12)
Clinical Journal of the American Society of Nephrology
Vol. 15, Issue 12
December 07, 2020
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Higher-Dose Sitagliptin and the Risk of Congestive Heart Failure in Older Adults with CKD
Flory T. Muanda, Matthew A. Weir, Lavanya Bathini, Kristin K. Clemens, Vlado Perkovic, Manish M. Sood, Eric McArthur, Jessica M. Sontrop, Richard B. Kim, Amit X. Garg
CJASN Dec 2020, 15 (12) 1728-1739; DOI: 10.2215/CJN.08310520

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Higher-Dose Sitagliptin and the Risk of Congestive Heart Failure in Older Adults with CKD
Flory T. Muanda, Matthew A. Weir, Lavanya Bathini, Kristin K. Clemens, Vlado Perkovic, Manish M. Sood, Eric McArthur, Jessica M. Sontrop, Richard B. Kim, Amit X. Garg
CJASN Dec 2020, 15 (12) 1728-1739; DOI: 10.2215/CJN.08310520
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