The researchers have published the study covered in this abstract on Research Square as a preprint that has not yet been peer-reviewed.
Key findings
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In patients with advanced diabetic kidney disease (DKD; estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), treatment with a glucagon-like peptide-1 (GLP-1) agonist had a neutral effect on cardiovascular outcomes but was significantly associated with preservation of renal function and improved survival when matched for propensity, a retrospective observational data analysis of more than 2000 people with type 2 diabetes in Taiwan.
Why this matters
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Cardiovascular disease is the leading cause of death in people with type 2 diabetes and among those with chronic kidney disease.
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GLP-1 agonists reduce total mortality and cardiovascular death in people with type 2 diabetes, but their role in patients with advanced DKD is controversial.
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Research on the effect of GLP-1 agonists on cardiovascular outcomes in patients with advanced DKD is limited. Studies evaluating GLP-1 agonists in people with type 2 diabetes generally excluded those with advanced DKD and completely excluded those with end-stage renal disease (eGFR < 30 mL/min/1.73 m2).
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Treatment with GLP-1 agonists was associated with a significant reduction in composite cardiovascular outcomes in people with type 2 diabetes and relatively good kidney function (eGFR > 30 mL/min/1.73 m2), but among people with type 2 diabetes and lower levels of renal function, studies show neutral composite levels of cardiovascular outcomes. However, limitations of previous studies include being primarily based on subgroup analysis or including a limited sample of patients.
I study design
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Retrospective analysis of observational data from nearly 9,000 people in Taiwan with type 2 diabetes and eGFR < 30 mL/min/1.73 m2 who received a first prescription for a GLP-1 agonist or dipeptidyl peptidase 4 (DPP-4) inhibitor. in 2012 2021 and had the data necessary for this analysis in their records.
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The data comes from the largest multi-institutional electronic medical record database in Taiwan, which includes two medical centers and five general hospitals and information on more than 11 million patients from 2001 to 2019.
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The researchers used a propensity score to match 602 people treated with a GLP-1 agonist to 1,479 people treated with a DPP-4 inhibitor.
Key results
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During a median follow-up of 2.1 years, the incidence of the composite cardiovascular outcome (cardiovascular death, myocardial infarction, and ischemic stroke) was not significantly different between the GLP-1 agonist and DPP-4 inhibitor groups, with levels incidence rates of 13.0% and 13.8%, respectively, and a negligible hazard ratio of 0.88. The frequencies of each of the three components of the composite endpoint were also not significantly different between the two groups.
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Progression to end-stage renal disease on dialysis was significantly lower in those treated with a GLP-1 agonist compared to a DPP-4 inhibitor, with incidence rates of 23.4% and 27.5%, respectively. and a significant hazard ratio of 0.72.
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The incidence of a greater than 50% decline in eGFR from baseline was 32.2% with GLP-1 agonist treatment compared with 35.9% with a DPP-4 inhibitor, with a significant hazard ratio of 0.74.
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The median time until patients needed new dialysis was 1.9 years with GLP-1 agonist treatment and 1.3 years with DPP-4 inhibitor treatment, a significant difference.
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The rate of death from any cause was 18.4% with GLP-1 agonist treatment compared with 25.1% with DPP-4 inhibitor treatment, a hazard ratio of 0.71, which was significant.
Limits
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Because the study is a retrospective analysis of observational data, it cannot prove a causal relationship.
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The study may be subject to residual confounding despite propensity-score matching.
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Data comes from health records, which may include coding errors.
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Compliance with treatment is unknown.
Disclosures
This is an abstract of a preprint research study, “Cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease,” by researchers in Taiwan at Research Square and brought to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found at researchsquare.com.
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Cite this: GLP-1 agonists protect the kidney in type 2 diabetes with advanced DKD – Medscape – January 31, 2023
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