#1319

The Outcomes of SGLT-2 Inhibitor Utilization in Patients with Non-metastatic Renal Cell Carcinomas and Type 2 Diabetes Mellitus

T. Hsu¹, J. Chen², V. Wu³, J. Chueh¹

¹National Taiwan University Hospital, Department of Urology, Taipei, Taiwan
²Chi Mei Medical Center, Department of Nephrology, Tainan, Taiwan
³National Taiwan University Hospital, Department of Nephrology, Taipei, Taiwan

Introduction:

This study aims to investigate the associations between SGLT-2i use and clinical outcomes, including all-cause mortality (ACM), major adverse kidney events (MAKE), and major adverse cardiac events (MACE), in patients with T2DM and non-metastatic renal cell carcinoma (RCC).

Material and methods:

This study utilized data from the TriNetX database. Our inclusion criteria consisted of 18 to 80-year-old patients with T2DM who received SGLT-2i therapy within 6 months after the diagnosis of RCC, classified under the ICD-10 code C64. The control group comprised T2DM patients diagnosed with C64 who had no record of SGLT-2i use within 5 years following the diagnosis. We excluded patients who died within 6 months after the diagnosis of C64. The primary outcome of this study was ACM, with secondary outcomes including MAKE, encompassing dialysis, renal function deterioration, and death, and MACE, including ischemic and hemorrhagic stroke, acute myocardial infarction, cardiac arrest, and death. Detailed analyses for components were also demonstrated. Index date was defined as the date of SGLT-2i initiation following the C64 diagnosis in the SGLT-2i group to avoid immortal time bias, and defined as the C64 diagnosis date for the non-user group.

Results:

27641 patients were analyzed, and after applying propensity score matching, 2 balanced cohorts were set: 908 SGLT-2i users and an equal number of non-users. The 2 groups were well-matched in terms of most relevant factors. Following the targeted 5-year follow-up, SGLT-2i users demonstrated a significantly lower ACM rate (aHR=0.277) and MAKE rate (aHR=0.434). However, the incidence of MACE was similar between groups. In specificity analyses, a significant reduction of risks for Dialysis (aHR=0.465) and progressing to CKD stage 5 or ESRD (aHR=0.479) were confirmed. Landmark analysis was conducted at 2, 3, 4, and 5 years. The findings consistently demonstrated significant improvements in ACM and MAKE outcomes for SGLT-2i users. The potential adverse effects of SGLT-2i use were assessed. The use of SGLT-2i was not associated with an increased risk of acute kidney injury, urinary tract infection, or diabetic ketoacidosis.