Transitional changes in medication‐initiator cohort profiles in persons with chronic kidney disease and type 2 diabetes—A hospital‐based cohort study in Japan

AIMS: To describe temporal changes in the characteristics of medication-initiator cohorts in persons with chronic kidney disease (CKD) and type 2 diabetes (T2D). MATERIALS AND METHODS: Adults with CKD and T2D initiating sodium-glucose cotransporter-2 inhibitors (SGLT-2i) or glucagon-like peptide-1 receptor agonists (GLP-1RA) were identified in the Japan Chronic Kidney Disease Database Extension in each of the two study periods (Period I: 1 January 2014-30 June 2021; Period II: 1 July 2021-31 December 2022). For each cohort, baseline characteristics and the standard mean differences (SMD) between periods I and II were assessed. RESULTS: During study periods I and II, 1157 and 1122 SGLT-2i, and 329 and 369 GLP-1RA new users were identified, respectively. All four cohorts had similar age, sex and comorbidity patterns, with a mean age spanning 66.1-69.5 years and 60%-70% being male. More than 80% of persons had hypertension and 60% had congestive heart failure. In the SGLT-2i cohorts, we observed a decrease in prior metformin and dipeptidyl peptidase-4 inhibitor use (SMD ≥0.5 and <0.8), and an increase in the number of persons with no T2D medications other than insulin between periods (SMD >0.8). In the GLP-1RA cohorts, there was a medium decrease in persons using insulin. CONCLUSIONS: With the introduction of new treatments and emerging evidence supporting cardio-renal protective effects in people with CKD and T2D, notable changes in baseline treatment were observed in the medication-initiator cohort characteristics. These findings suggest the earlier use of cardio-renal protective medications in the course of T2D.