The American journal of medicine · 2025
Cardio-renal outcomes in type 2 diabetes patients with advanced chronic kidney disease on SGLT2 inhibitors or GLP-1 receptor agonists.
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Chen Jia-Jin, Tsai Ming-Hsien, Ho Wen-Yu, Fang Yu-Wei, Chen Meng-Ting, Hsiao Ching-Chung
Аннотация
BACKGROUND: GLP-1 RA and SGLT2i have demonstrated cardio-renal protective effects in randomized clinical trials. However, their comparative cardio-renal benefits in diabetes patients with stage 4-5 chronic kidney disease remain underexplored.
METHODS: This is a retrospective study with target trial emulation design using TriNetX platform. Adults type 2 diabetes mellitus, stage 4-5 chronic kidney disease patients who were new initiation of GLP-1 RA compared to SGLT2i were enrolled.
OUTCOMES: major adverse kidney events (MAKE), major adverse cardiovascular events (MACE), and all-cause mortality. Hazard ratios (HRs) were calculated for outcomes in 1:1 propensity score-matched patients.
RESULTS: A total of 7,458 participants were included in each group, with a mean eGFR of 23-24 mL/min/1.73 m². New users of GLP-1 RAs had a higher HR for MAKE (HR 1.05, 95% CI 1.0-1.1) & dialysis (HR 1.09, 95% CI 1.03-1.15), but similar HRs for all-cause mortality (HR 0.98, 95% CI 0.91-1.05) and MACE (HR 0.97, 95% CI 0.93-1.01) compared with SGLT2i users, despite a lower HR for heart failure (HR 0.94, 95% CI 0.90-0.99). Among new GLP-1 RA users, higher HRs for MAKE occurred in subgroup of males and patients without heart failure.
CONCLUSIONS: In patients with type 2 diabetes and stage 4-5 chronic kidney disease, initiating an SGLT2i, relative to a GLP-1 RA, was associated with a lower risk of adverse kidney events and comparable cardiovascular and mortality risks. Further studies are warranted to confirm these findings.
METHODS: This is a retrospective study with target trial emulation design using TriNetX platform. Adults type 2 diabetes mellitus, stage 4-5 chronic kidney disease patients who were new initiation of GLP-1 RA compared to SGLT2i were enrolled.
OUTCOMES: major adverse kidney events (MAKE), major adverse cardiovascular events (MACE), and all-cause mortality. Hazard ratios (HRs) were calculated for outcomes in 1:1 propensity score-matched patients.
RESULTS: A total of 7,458 participants were included in each group, with a mean eGFR of 23-24 mL/min/1.73 m². New users of GLP-1 RAs had a higher HR for MAKE (HR 1.05, 95% CI 1.0-1.1) & dialysis (HR 1.09, 95% CI 1.03-1.15), but similar HRs for all-cause mortality (HR 0.98, 95% CI 0.91-1.05) and MACE (HR 0.97, 95% CI 0.93-1.01) compared with SGLT2i users, despite a lower HR for heart failure (HR 0.94, 95% CI 0.90-0.99). Among new GLP-1 RA users, higher HRs for MAKE occurred in subgroup of males and patients without heart failure.
CONCLUSIONS: In patients with type 2 diabetes and stage 4-5 chronic kidney disease, initiating an SGLT2i, relative to a GLP-1 RA, was associated with a lower risk of adverse kidney events and comparable cardiovascular and mortality risks. Further studies are warranted to confirm these findings.