Effects of dipeptidyl peptidase-4 inhibitors on renal outcomes in patients with type 2 diabetes: A systematic review and meta-analysis

Jae Hyun Bae, Sunhee Kim, Eun Gee Park, Sin Gon Kim, Seokyung Hahn, Nam Hoon Kim

Research output: Contribution to journalArticle

3 Citations (Scopus)


Background: To investigate the effects of dipeptidyl peptidase-4 (DPP-4) inhibitors on renal outcomes in patients with type 2 diabetes. Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched to identify randomized controlled trials (RCTs) of DPP-4 inhibitors from inception to September 2017. We selected eligible RCTs comparing DPP-4 inhibitors with placebo or other antidiabetic agents and reporting at least one renal outcome. A meta-analysis was conducted to calculate standardized mean differences, weighted mean differences (WMDs), relative risks (RRs), and 95% confidence intervals (CIs) for each renal outcome. Results: We included 23 RCTs with 19 publications involving 41,359 patients. Overall changes in urine albumin-to-creatinine ratio were comparable between DPP-4 inhibitors and controls (P=0.150). However, DPP-4 inhibitors were associated with significantly lower risk of incident microalbuminuria (RR, 0.89; 95% CI, 0.80 to 0.98; P=0.022) and macroalbuminuria (RR, 0.77; 95% CI, 0.61 to 0.97; P=0.027), as well as higher rates of regression of albuminuria (RR, 1.22; 95% CI, 1.10 to 1.35; P=<0.001) compared with controls. Although DPP-4 inhibitors were associated with small but significantly lower estimated glomerular filtration rate (WMD, −1.11 mL/min/1.73 m 2 ; 95% CI, −1.78 to −0.44; P=0.001), there was no difference in the risk of end-stage renal disease between two groups (RR, 0.93; 95% CI, 0.76 to 1.14; P=0.475). Conclusion: DPP-4 inhibitors had beneficial renal effects mainly by reducing the risk of development or progression of albuminuria compared with placebo or other antidiabetic agents.

Original languageEnglish
Pages (from-to)80-92
Number of pages13
JournalEndocrinology and Metabolism
Issue number1
Publication statusPublished - 2019 Mar 1



  • Albuminuria
  • Chronic
  • Diabetes complications
  • Diabetes mellitus, type 2
  • Diabetic nephropathies
  • Dipeptidyl-peptidase IV inhibitors
  • Glomerular filtration rate
  • Kidney failure
  • Meta-analysis
  • Systematic review

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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