Although several sulphonylureas are widely used in type 2 diabetes (T2D), their differential impacts on long-term major kidney outcomes remain unclear. This study aimed to investigate the effects of the two most commonly prescribed sulphonylureas, glimepiride and gliclazide, on kidney outcomes in patients with T2D.

A total of 4486 patients treated with either glimepiride or gliclazide for more than 2years were followed for up to 5.5years (median: 4.7years). A propensity score based on baseline characteristics was used to match 1427 patients treated with glimepiride with 1427 gliclazide-treated patients; incidences of end-stage renal disease (ESRD) and sustained doubling of creatinine to>132.6μmol/L (1.5mg/dL) were also compared.

In the matched cohort with 12,122 person-years of follow-up, there was no significant difference between groups in risk of ESRD [hazard ratio (HR): 0.57, 95% confidence interval (CI): 0.29–1.12] or doubling of creatinine (HR: 0.74, 95% CI: 0.44–1.26), although there was a trend towards higher risks in the glimepiride group. Subgroup analyses showed that, compared with glimepiride, gliclazide was associated with a lower risk of doubling of creatinine in patients with preserved renal function (glomerular filtration rate≥60mL/min/1.73m², HR: 0.21, 95% CI: 0.04–0.99) and good glycaemic control (HbA_1c<7%, HR: 0.35, 95% CI: 0.14–0.86), and in older subjects (≥62years, HR: 0.52, 95% CI: 0.27–0.99).

In a real-life setting, there was no significant difference in clinical outcomes of kidney disease for patients treated with glimepiride vs gliclazide. However, gliclazide appeared to protect against renal complication progression in certain populations.