1603: SGLT-2 Inhibitors are Associated with Lower Risk of End Stage Renal Disease (ESRD) and Lower Mortality in ANCA-associated Vasculitis With Kidney Involvement

Background/Purpose: ANCA-associated vasculitis encompasses three main conditions: Granulomatosis with Polyangiitis (GPA, previously called Wegener’s granulomatosis), Eosinophilic Granulomatosis with Polyangiitis (EGPA, previously called Churg-Strauss), and microscopic polyangiitis. These three conditions are known to cause kidney issues. SGLT-2 inhibitors (SGLT-2i) have demonstrated the ability to protect some aspects of kidney function in patients with Type 2 diabetes. This study intends to investigate effects of SGLT-2 inhibitors on renal-related outcome measures in patients with ANCA-associated vasculitis and Type 2 diabetes.

Methods: This retrospective cohort study used TriNetX, a global, federated network of databases that provides de-identified data of over 113 million patients. We used all applicable ICD-10 codes to identify patients with GPA, EGPA, or microscopic polyangiitis and Type 2 diabetes, and if they take SLGT-2i for diabetes treatment. The participants in the study ranged from ages 18-80 years and were balanced based on age and sex. These cohorts filtered out patients who had received a previous diagnosis/procedure of Chronic Kidney Disease (CKD), End Stage Renal Disease (ESRD), unclassified kidney disorders, dialysis, and kidney transplant.

Results: We identified 219 patients who used SGLT-2i at time of diagnosis of ANCA-associated vasculitis with kidney involvement. Among these patients, we identified lower incidence of ESRD in patients who used SGLT-2i compared to age- and sex-matched controls. Age at index was 62.9 in the SGLT-2i group, and 64.1 in the control group. Specifically, we identified 33 patients who took SGLT-2i and were diagnosed with ESRD, compared to the 57 patients who did not take SGLT-2i (p=0.003). 10 patients on SGLT-2i received kidney transplants, and 0 became infected. 18 patients received kidney transplants but did not take SLGT-2 inhibitors, and 10 of their transplants became infected (p=0.001). We did not find statistically significant difference in outcomes related to kidney transplant status (p=0.115) and dialysis services (p=0.062). Moreover, patients with ANCA-associated vasculitis who used SGLT2 inhibitors had a survival probability (outcomes: ESRD, stage 5 CKD, dialysis services, kidney transplant status, or kidney transplant infection) of 90% five years after meeting the selected criteria, as opposed to the 72% who did not take SGLT-2i (p=0.03).

Conclusion: Patients with ANCA-associated vasculitis who used SGLT-2i at time of diagnosis of ANCA-associated vasculitis had lower risk of ESRD and kidney transplant infection (p< 0.05). Also, significantly lower 5-year mortality was found in SGLT-2i users. These findings highlight a potential survival and nephroprotective role of SGLT-2i in ANCA-associated vasculitis.