BACKGROUND: Few therapies improve cardiovascular outcomes for people with kidney failure. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce cardiovascular risk in patients with non-dialysis-dependent chronic kidney disease, but the cardiovascular benefits in patients with kidney failure remain uncertain. The objective of this study was to compare cardiovascular outcomes among patients with kidney failure and type 2 diabetes newly initiated on GLP-1 RA versus other antiglycemic agents.
METHODS: We analyzed electronic health records, Medicare claims, and Part D data from the United States Renal Data System (2011-2021) to identify new users of GLP-1 RA (n=3,629), dipeptidyl peptidase-4 inhibitors (DPP4i; n=21,369), and sulfonylureas (n=32,296) among patients with type 2 diabetes receiving maintenance dialysis. For the primary analysis, we performed 1:1 propensity score matching of GLP-1 RA to DPP4i initiators using 61 covariates. A prespecified secondary analysis compared propensity score-matched initiators of GLP-1 RA and sulfonylureas. The primary outcome was a modified major adverse cardiovascular events (MACE) composite of myocardial infarction, stroke, or all-cause mortality. Secondary outcomes included the individual components of the primary outcome and hospitalizations for heart failure. Cause-specific Cox models were used to estimate hazard ratios (HRs).
RESULTS: Among 3,284 matched pairs of GLP-1 RA and DPP4i initiators, GLP-1 RA use was associated with lower risks of MACE (HR 0.87; 95% CI 0.78-0.97), all-cause mortality (HR 0.83, 95% CI 0.74-0.94), and heart failure hospitalization (HR 0.90, 95% CI 0.83-0.99) over up to 2 years of follow-up. Among 2,792 matched pairs, GLP-1 RA and sulfonylurea initiators, GLP-1 RA was associated with lower risks of MACE (HR 0.83; 95% CI 0.74-0.93) and all-cause mortality (HR 0.80; 95% CI 0.69-0.91).
CONCLUSIONS: Among patients with type 2 diabetes receiving maintenance dialysis, GLP-1 RA initiation was associated with lower risk of cardiovascular events and all-cause mortality compared to other commonly prescribed antiglycemic agents.
