■ 学会名
World Congress of Nephrology 2026

■ 発表日
2026/03/28

■ 筆頭演者
Tatsuhiko Azegami
Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Keio University School of Medicine

■ 共同演者
Hidehiro Kaneko¹,² ,Akira Okada³ ,Yuta Suzuki¹,⁴ ,Toshiyuki Ko¹ ,Kazuki Aoyama⁵ ,Takashin Nakayama⁵ ,Yuya Kimura⁶ ,Katsuhito Fujiu¹,² ,Norifumi Takeda² ,Hiroyuki Morita ² ,Takashi Yokoo⁷ ,Koichi Node⁸ ,Masaomi Nangaku⁹ ,Norihiko Takeda¹ ,Hideo Yasunaga¹⁰ ,Kaori Hayashi⁵
1) Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
2) Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
3) Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
4) Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, Saitama, Japan.
5) Division of Nephrology, Endocrinology, and Metabolism, Department of Internal Medicine, Keio University School of Medicine, Japan.
6) Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
7) Division of Nephrology and Hypertension, Department of Internal Medicine, Jikei University School of Medicine, Tokyo, Japan.
8) Department of Cardiovascular Medicine, Saga University, Saga, Japan.
9) Division of Nephrology and Endocrinology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
10) Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

■ 要旨
Sodium–glucose cotransporter 2 (SGLT2) inhibitors reduce kidney and cardiovascular risk in diabetic kidney disease (DKD), but evidence on mortality in older adults remains scarce, especially in real-world settings where multimorbidity is frequent. We emulated a target trial using a nationwide claims and health checkup database in Japan. Patients aged 65 years or older with DKD who newly initiated an SGLT2 inhibitor or a dipeptidyl peptidase-4 (DPP4) inhibitor between 2016 and 2023 were included. A total of 5,371 individuals were eligible. The primary outcome was all-cause mortality. Propensity score overlap weighting was applied, and Cox proportional hazards models were used for intention-to-treat and per-protocol analyses. During a median follow-up of 2.23 years, 437 deaths occurred. Initiation of an SGLT2 inhibitor was associated with a lower risk of all-cause mortality compared with initiation of a DPP4 inhibitor (HR 0.51, 95% CI 0.38–0.70 in ITT; HR 0.50, 95% CI 0.35–0.73 in PP). Subgroup analyses suggested greater benefit in patients younger than 80 years and those with body mass index 22 kg/m² or higher, whereas the effect was attenuated in patients 80 years or older or with lower body mass index. Comorbidity burden did not substantially alter results.