Research Activities March 2013, No. 391
Sulfonylurea medication linked to kidney function decline among patients with diabetes
People with type 2 diabetes are at increased risk for end-stage kidney disease. In fact, diabetes accounts for 45 percent of all cases. People with diabetes may take a variety of oral medications to control their diabetes. A new study concludes that individuals taking the class of diabetes drugs known as sulfonylureas increase their risk for kidney function decline compared to patients using metformin or rosiglitazone. The study included 93,577 patients who received care from the Veterans Administration between 2001 and 2008. All had filled a prescription for an oral diabetes drug: 65 percent for metformin, 33 percent for a sulfonylurea, and 2 percent for rosiglitazone. The primary outcome looked at was a persistent decline in estimated glomerular filtration rate (eGFR), a measure of kidney function of 25 percent or more (eGFR event), or a diagnosis of end-stage renal disease (ESRD). The secondary outcome was an eGFR event, ESRD, or death.
All-cause mortality rates were highest for patients taking sulfonylureas and lowest for rosiglitazone. Compared to metformin users, those taking sulfonylureas had a 20 percent increased risk of an eGFR event, developing ESRD, or death. These findings support national and international recommendations that metformin be used as a first-line therapy for patients with type 2 diabetes in the early stages of kidney disease. The study was supported in part by the Agency for Healthcare Research and Quality (Contract No. 290-05-0042).
See "Comparative effectiveness of incident oral antidiabetic drugs on kidney function," by Adrian M. Hung, M.D., Christianne L. Roumie, M.D., Robert A. Greevy, Ph.D., and others in Kidney International 81, pp. 698-706, 2012.