SGLT2 Inhibitors vs GLP-1 Receptor Agonists for Kidney Outcomes in Individuals With Type 2 Diabetes
In a nationwide Danish target-trial-emulation study, starting an SGLT2 inhibitor instead of a GLP-1 receptor agonist was linked to a lower 5-year risk of chronic kidney disease and fewer acute kidney injury events in people with type 2 diabetes.
Study design
Using nationwide Danish registries, the authors emulated a target trial of 36,279 individuals with metformin-treated type 2 diabetes who initiated an SGLT2 inhibitor and 18,782 who initiated a GLP-1 receptor agonist between 2014 and 2020, with follow-up through October 2024. Co-primary outcomes were chronic kidney disease (40% eGFR decline, severe albuminuria, or kidney failure) and acute kidney injury, analyzed with inverse-probability-of-treatment weighting.
Key findings
The weighted 5-year risk of chronic kidney disease was 6.7% with SGLT2 inhibitors versus 8.2% with GLP-1 receptor agonists (risk ratio 0.81; risk difference -1.5%). The 5-year mean cumulative count of acute kidney injury per 100 individuals was 25.2 versus 28.7 (count ratio 0.88). Albuminuria and mortality were slightly lower with GLP-1 receptor agonists.
Clinical implications
For primary prevention of kidney disease in type 2 diabetes, SGLT2 inhibitors appear preferable for reducing chronic kidney disease and acute kidney injury, while the two classes are complementary and increasingly used together; reductions with SGLT2 inhibitors were most pronounced in patients without established kidney disease.
Category
Research
Source
JAMA Internal Medicine
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