Cardio-renal outcomes in type 2 diabetes patients with advanced chronic kidney disease on SGLT2 inhibitors or GLP-1 receptor agonists
In a large emulated-trial analysis of people with type 2 diabetes and stage 4-5 CKD, starting an SGLT2 inhibitor rather than a GLP-1 receptor agonist was linked to fewer kidney complications and a lower chance of needing dialysis, with similar heart and survival outcomes.
Background
SGLT2 inhibitors and GLP-1 receptor agonists both confer cardiorenal protection in type 2 diabetes, but their comparative effect in patients with advanced (stage 4-5) chronic kidney disease has been underexplored because such patients were largely excluded from the landmark trials.
Study design
Using the TriNetX platform and a target-trial-emulation design, the authors compared new initiators of GLP-1 receptor agonists with new initiators of SGLT2 inhibitors among adults with type 2 diabetes and stage 4-5 CKD (mean eGFR 23-24 mL/min/1.73 m2), with 7,458 patients in each 1:1 propensity-matched group.
Key findings
Compared with SGLT2 inhibitor users, GLP-1 receptor agonist users had a modestly higher risk of major adverse kidney events (HR 1.05, 95% CI 1.0-1.1) and dialysis (HR 1.09, 95% CI 1.03-1.15), similar all-cause mortality (HR 0.98) and MACE (HR 0.97), and a slightly lower risk of heart failure (HR 0.94, 95% CI 0.90-0.99).
Clinical implications
These data support favoring an SGLT2 inhibitor for kidney protection when choosing between the two classes in advanced diabetic CKD, while recognizing that the observational design warrants confirmation in dedicated randomized trials.
Category
Research
Source
The American Journal of Medicine
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