OBJECTIVES To estimate inappropriate dosing of dipeptidyl peptidase-4 (DPP-4) inhibitors and to assess the risk of emergency department visits, hypoglycemia, and mortality in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD) prescribed inappropriate DPP-4 inhibitor doses because limited real-world information is available regarding rates of DPP-4 inhibitor dose adjustment and its safety in patients with T2DM and CKD. PATIENTS AND METHODS We performed a retrospective observational cohort study of 82,332 patients aged 30 to 75 years with T2DM and CKD being treated with DPP-4 inhibitors from January 1, 2012, through December 31, 2014, using the Korean National Health Information Database. We divided the patients according to the prescription of DPP-4 inhibitor with or without dose adjustment according to estimated glomerular filtration rate. The incidences of emergency department visits, hypoglycemia, and mortality were assessed using hazard ratios estimated using Cox proportional hazards regression modeling. RESULTS Approximately 40% of patients with T2DM and CKD were prescribed an inappropriate dose of DPP-4 inhibitor from 2009 through 2011; this proportion decreased to 24.4% in 2015. Hazard ratios (95% CIs) for inappropriate vs appropriate dosing of DPP-4 inhibitors were 1.115 (1.005-1.237) for mortality, 1.074 (1.018-1.133) for emergency department visits, and 1.192 (1.054-1.349) for severe hypoglycemia after multivariable adjustment for confounding factors. CONCLUSION One of every 3 patients with T2DM and CKD received inappropriate dosing of DPP-4 inhibitor, which was associated with high risk of emergency department visits, severe hypoglycemia, and mortality.

中文翻译：

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2型糖尿病患者不适当的肾脏剂量调整Depteptidyl Peptidase-4抑制剂的结果：基于人群的研究。

目的评估二肽基肽酶-4（DPP-4）抑制剂的不当剂量，并评估开处方不当DPP的2型糖尿病（T2DM）和慢性肾脏病（CKD）患者的急诊就诊，低血糖和死亡率的风险-4抑制剂的剂量，因为关于DPP-4抑制剂剂量调整率及其在T2DM和CKD患者中的安全性的可用的现实世界信息有限。患者与方法我们使用韩国国家健康信息数据库，对2012年1月1日至2014年12月31日之间接受过DPP-4抑制剂治疗的2 332例30岁至75岁的T2DM和CKD患者进行了回顾性观察队列研究。我们根据DPP-4抑制剂的处方将患者分为两组，根据估计的肾小球滤过率调整或不调整剂量。急诊就诊，低血糖症和死亡率的发生率通过使用Cox比例风险回归模型估算的风险比进行评估。结果从2009年至2011年，约40％的T2DM和CKD患者被处方了不适当的DPP-4抑制剂剂量。到2015年，这一比例下降到24.4％。DPP-4抑制剂剂量不当与适当剂量的危险比（95％CI）分别是死亡率1.115（1.005-1.237），急诊就诊1.074（1.018-1.133）和1.192（ 1.054-1.349）用于多因素调整后的严重低血糖症。