title: Effects of DPP-4 inhibitors on cardiovascular outcomes in patients with type 2 diabetes and end-stage renal disease.
abstract: BACKGROUND
  Recent clinical trials have evaluated the cardiovascular outcomes of dipeptidyl peptidase-4 (DPP-4) inhibitors in patients with type 2 diabetes mellitus (T2DM), but those with end-stage renal disease (ESRD) were ineligible for participation in these trials. We aimed to characterize the impact of DPP-4 inhibitors on major adverse cardiovascular events (MACEs) in patients with T2DM and ESRD undergoing chronic dialysis.
  
  
  METHODS
  This nationwide observational study utilized data from 3556 patients aged ≥20years with T2DM and ESRD who initiated treatment with DPP-4 inhibitors between 1 March 2009 and 31 June 2013, retrieved from Taiwan's National Health Insurance Research Database. Each DPP-4 inhibitor user was matched to a non-user control subject using propensity scores. The primary outcomes were all-cause mortality and MACEs (ischemic stroke and myocardial infarction). The secondary outcomes were hospitalization for heart failure and hypoglycemia. All subjects were followed until death or 31 December 2013.
  
  
  RESULTS
  Compared with non-users, DPP-4 inhibitor users had lower risks of all-cause mortality (hazard ratio [HR] 0.43, 95% confidence interval [CI] 0.39-0.47), MACEs (HR 0.76, 95% CI 0.65-0.90), and ischemic stroke (HR 0.77, 95% CI 0.61-0.97); the risks of myocardial infarction and hospitalization for heart failure and hypoglycemia did not differ. This treatment effect remained consistent in subgroup analyses according to age, sex, comorbidities, dialysis modality, and insulin use.
  
  
  CONCLUSIONS
  In this nationwide ESRD cohort, DPP-4 inhibitor use was associated with reduced risks of all-cause mortality and ischemic stroke.
authors.affiliation: Division of Cardiology, Department of Medicine, Taipei City Hospital, Heping, Fuyou Branch, Taipei, Taiwan.
authors.forename: Shang-Yih
authors.initials: SY
authors.lastname: Chan
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Shuo-Ming
authors.initials: SM
authors.lastname: Ou
authors.affiliation: Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Nephrology, Department of Medicine, Taipei City Hospital, Heping, Fuyou Branch, Taipei, Taiwan. Electronic address: ytchen0117@gmail.com.
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Taipei Veterans General Hospital, Yuanshan Branch, Yilan, Taiwan; Deran Clinic, Yilan, Taiwan. Electronic address: b001089010@tmu.edu.tw.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Shih
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D054873:Dipeptidyl-Peptidase IV Inhibitors / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D013624:Taiwan
chemical_list: D054873:Dipeptidyl-Peptidase IV Inhibitors
keywords: Diabetes mellitus; Dipeptidyl peptidase-4 inhibitor; End-stage renal disease; Major adverse cardiovascular events; Mortality