{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T13:13:10Z","timestamp":1771247590809,"version":"3.50.1"},"reference-count":53,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,7,3]],"date-time":"2025-07-03T00:00:00Z","timestamp":1751500800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern Med"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Patients with diabetes and Stage 5 chronic kidney disease (CKD) not on dialysis are susceptible to renal replacement therapy and severe complications. Among limited antidiabetic options in this vulnerable population, dipeptidyl peptidase\u20104 (DPP\u20104) inhibitors (DPP\u20104i) are widely used; however, supporting evidence is scant. This study assessed severe renal outcomes associated with DPP\u20104i in diabetic and pre\u2010dialysis patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study employed an active\u2010comparator and propensity score\u2013based inverse probability of treatment weighting approach, using Taiwan's nationwide healthcare claims database from 2012 to 2020. We identified patients with diabetes and CKD stage 5 not on dialysis who received erythropoietin (erythropoietin\u2010stimulating agent), a drug reimbursed for patients with an estimated glomerular filtration rate &lt;15\u00a0mL\/min\/1.73\u00a0m\n                      <jats:sup>2<\/jats:sup>\n                      . The primary outcome was a composite of renal replacement therapy, renal death, and kidney\u2010related hospitalization events, and secondary outcomes included each component of the composite and hypoglycemia.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 7271 diabetic and pre\u2010dialysis patients with CKD stage 5, of whom 5028 received DPP\u20104i and 2243 received meglitinides. DPP\u20104i were associated with a 14% reduced risk of the renal composite outcome compared to meglitinides (weighted hazard ratio [HR], 0.86; 95% confidence interval, 0.81\u20130.92). Individual component analysis revealed that the decreased risk was confined to renal replacement therapy, with a 17% reduction. DPP\u20104i was related to a 41% decreased severe hypoglycemia risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In diabetic and pre\u2010dialysis patients with CKD stage 5, DPP\u20104i are related to a lower risk of the renal composite outcome, primarily driven by lower renal dialysis risk, and a lower hypoglycemia risk compared with meglitinides.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/joim.20112","type":"journal-article","created":{"date-parts":[[2025,7,4]],"date-time":"2025-07-04T00:15:22Z","timestamp":1751588122000},"page":"214-227","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Use of dipeptidyl peptidase\u20104 inhibitors is associated with lower risk of severe renal outcomes in pre\u2010dialysis patients with Type 2 diabetes"],"prefix":"10.1111","volume":"298","author":[{"given":"Tung\u2010Ying","family":"Hung","sequence":"first","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzu\u2010Chieh","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying\u2010Jay","family":"Liou","sequence":"additional","affiliation":[{"name":"Faculty of Medicine National Yang Ming Chiao Tung University Taipei Taiwan"},{"name":"Department of Psychiatry Taipei Veterans General Hospital Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzu\u2010Han","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu\u2010Juei","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biochemistry National Defense Medical Center Taipei Taiwan"},{"name":"Division of Nephrology Department of Medicine Tri\u2010Service General Hospital National Defense Medical Center Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liang\u2010Yu","family":"Lin","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism Department of Medicine Taipei Veterans General Hospital Taipei Taiwan"},{"name":"College of Medicine National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meng\u2010Ting","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy National Yang Ming Chiao Tung University Taipei Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,3]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3390\/kidneydial2030038"},{"key":"e_1_2_12_3_1","volume-title":"IDF diabetes atlas","author":"International Diabetes Federation","year":"2021"},{"key":"e_1_2_12_4_1","volume-title":"Diabetes atlas reports: Diabetes and kidney disease","author":"International Diabetes Federation","year":"2023"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.09021010"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003954"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2021.672350"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00570-3"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1811744"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2204233"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2024816"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.kint.2022.06.008"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.3949\/ccjm.91a.23034"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1616011"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2403347"},{"key":"e_1_2_12_16_1","unstructured":"National Health Research Institutes & Taiwan Society of Nephrology.2022 annual report on kidney disease in Taiwan [Electronic book in Traditional Chinese]. 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