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Association Between Use of Dipeptidyl Peptidase-4 Inhibitors and the Risk of Acute Kidney Injury: A Nested Case-Control Study

  • Chia-Jen Shih
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Deran Clinic, Yilan, Taiwan
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  • Yi-Jung Lee
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yuan-Hao Lo
    Affiliations
    Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan
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  • Shu-Chen Kuo
    Affiliations
    School of Medicine, National Yang-Ming University, Taipei, Taiwan

    National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan

    Division of Infectious Diseases, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Shuo-Ming Ou
    Correspondence
    Shuo-Ming Ou, MD, Department of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan 112.
    Affiliations
    Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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  • Yung-Tai Chen
    Correspondence
    Correspondence: Address to Yung-Tai Chen, MD, Department of Nephrology, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan 100.
    Affiliations
    Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan

    Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping Fuyou Branch, Taipei, Taiwan
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      Abstract

      Objective

      To examine the risk of acute kidney injury (AKI) in a nationwide cohort of patients with type 2 diabetes initiating dipeptidyl peptidase-4 (DPP-4) inhibitors.

      Patients and Methods

      This nested case-control study of a cohort of adult DPP-4 inhibitor users with type 2 diabetes who were hospitalized for AKI between January 1, 2010, and December 31, 2013, was conducted using Taiwan's National Health Insurance Research Database. Each AKI case was matched with one control subject according to duration of follow-up, age, sex, urbanization level, monthly income, comorbidity severity, and well-known predisposing factors for AKI. Odds ratios (ORs) for AKI were calculated according to current, recent, or past use of DPP-4 inhibitors.

      Results

      A total of 6752 cases with AKI and 6752 matched controls were analyzed. The exposure prevalence of DPP-4 inhibitor use in the previous year was higher among patients with AKI (adjusted OR, 1.20; 95% CI, 1.05-1.36; P=.006). In a stratified analysis, the association was significant for current DPP-4 inhibitor use (adjusted OR, 1.26; 95% CI, 1.08-1.48; P=.004), but not for recent or past use.

      Conclusion

      In this large contemporary cohort, DPP-4 inhibitor users had an increased risk of AKI development compared with nonusers. Further research is warranted to investigate the mechanism underlying this association.

      Abbreviations and Acronyms:

      AKI (acute kidney injury), CKD (chronic kidney disease), DPP-4 (dipeptidyl peptidase-4), ICD-9-CM (International Classification of Disease, Ninth Revision, Clinical Modification), NHIRD (National Health Insurance Research Database), OR (odds ratios), T2DM (type 2 diabetes mellitus), eGFR (estimated glomerular filtration rate)
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