Autor:innen:
H. Heerspink (Groningen, NL)
N. Sattar (Glasgow, GB)
I. Pavo (Indianapolis, Indiana, US)
A. Haupt (Indianapolis, Indiana, US)
K. Duffin (Indianapolis, Indiana, US)
Z. Yang (Indianapolis, Indiana, US)
R. Wiese (Indianapolis, Indiana, US)
K. Tuttle (Spokane, Washington, US)
D. Cherney (Toronto, Ontario, CA)
J. Seufert (Freiburg, DE)
Question: Does treatment with tirzepatide (TZP 5, 10, 15mg) result in more favourable changes of markers of diabetic kidney disease in people with T2D and high CV risk compared to iGlar?
Methodology: We compared progression to pre-specified kidney endpoints between TZP and iGlar. Composite kidney outcomes in SURPASS-4 were analysed: endpoint 1 (eGFR [CKD-EPI] decline ≥ 40% from baseline, renal death, progression to end stage kidney disease, new onset macroalbuminuria) and endpoint 2 (endpoint 1 without new onset macroalbuminuria). Data were examined within the entire study population, and in subgroups defined by baseline SGLT2i use, urine albumin-creatinine ratio (UACR) ≥ 30mg/g, eGFR < 60ml/min/1.73m² and in those at high risk for kidney related outcomes, defined as eGFR < 75ml/min per 1.73m² and macroalbuminuria, or eGFR < 45 ml/min per 1.73m².
Results: At baseline, participants (N=1995, age 63.6 years, HbA1c 8.5%) had a mean eGFR of 81.3ml/min per 1.73m²; 17% had eGFR < 60 ml/min per 1.73m², 28% microalbuminuria (UACR 30-300mg/g) and 8% macroalbuminuria (UACR > 300mg/g). During the follow-up to 104 weeks, TZP participants experienced significantly fewer renal outcomes versus iGlar (HR [95% CI] = 0.58 [0.43, 0.80]), especially new onset of macroalbuminuria (0.41 [0.26, 0.66]) was reduced, while the new onset of eGFR decline ≥ 40% (0.86 [0.56, 1.33]) was not significantly different between groups.
Conclusions: In people with T2D and high cardiovascular risk, TZP reduced markers of diabetic kidney disease risk.