Diabetes & metabolism · 2026
Comparative cardiovascular effectiveness of GLP-1RAs versus DPP-4is in dialysis patients with type 2 diabetes: a target trial emulation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Shimada Hiroki, Fukasawa Toshiki, Mizuno Kayoko, Okazawa Yuki, Yokogawa Kasumi, Kawakami Koji
Аннотация
AIM: Patients with type 2 diabetes (T2D) receiving dialysis have a very high risk of cardiovascular events. Evidence for the cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in this population remains limited. Here, we assessed this issue using a target trial emulation framework.
METHODS: We conducted a cohort study using a Japanese administrative claims database. We included adults aged 20 years or older with T2D receiving maintenance dialysis who initiated a GLP-1RA or a DPP-4i between April 2015 and March 2023. The primary outcome was the 3-year risk of major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, stroke, and cardiovascular death. The observational analogue of the per-protocol effect was estimated using pooled logistic regression with inverse probability weighting to adjust for baseline and time-varying confounders.
RESULTS: Among 4793 patients (557 GLP-1RA initiators and 4236 DPP-4i initiators), the estimated 3-year risk of MACE was 29.7% (95% CI, 22.3% to 38.3%) for GLP-1RA users and 37.6% (95% CI, 35.2% to 40.8%) for DPP-4i users, giving a risk difference of -8.0% (95% CI, -15.5% to 0.9%) and risk ratio of 0.79 (95% CI, 0.59 to 1.03).
CONCLUSION: Compared with DPP-4is, sustained use of GLP-1RAs may reduce the risk of MACE among patients with T2D receiving maintenance dialysis. These findings suggest a potential cardiovascular benefit but require confirmation in randomized controlled trials before introduction into clinical practice.
METHODS: We conducted a cohort study using a Japanese administrative claims database. We included adults aged 20 years or older with T2D receiving maintenance dialysis who initiated a GLP-1RA or a DPP-4i between April 2015 and March 2023. The primary outcome was the 3-year risk of major adverse cardiovascular events (MACE), defined as a composite of acute myocardial infarction, stroke, and cardiovascular death. The observational analogue of the per-protocol effect was estimated using pooled logistic regression with inverse probability weighting to adjust for baseline and time-varying confounders.
RESULTS: Among 4793 patients (557 GLP-1RA initiators and 4236 DPP-4i initiators), the estimated 3-year risk of MACE was 29.7% (95% CI, 22.3% to 38.3%) for GLP-1RA users and 37.6% (95% CI, 35.2% to 40.8%) for DPP-4i users, giving a risk difference of -8.0% (95% CI, -15.5% to 0.9%) and risk ratio of 0.79 (95% CI, 0.59 to 1.03).
CONCLUSION: Compared with DPP-4is, sustained use of GLP-1RAs may reduce the risk of MACE among patients with T2D receiving maintenance dialysis. These findings suggest a potential cardiovascular benefit but require confirmation in randomized controlled trials before introduction into clinical practice.