Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are contributors to the health burden and are associated with increased mortality and cardiovascular events. Type 2 diabetes is the most common cause of CKD, and both diabetes and CKD are associated with increased all-cause mortality and increased rates of infection and cardiovascular events.

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A recent study suggests that the use of GLP-1 receptor agonists was associated with better outcomes compared with the use of DPP-4 inhibitors among patients with type 2 diabetes and advanced-stage chronic kidney disease. The study findings were published in the JAMA Network Open on March 07, 2022.

Unlike SGLT-2 inhibitors, GLP-1 receptor agonists can be used in patients with advanced-stage CKD or ESKD. However, real-world studies comparing GLP-1 receptor agonists with DPP-4 inhibitors for the treatment of patients with advanced-stage CKD or ESKD are rare. Therefore, Dr Jia-Jin Chen and his team conducted to assess, whether the use of GLP-1 receptor agonists in a population with diabetes and advanced-stage CKD or ESKD is associated with better outcomes compared with the use of DPP-4 inhibitors.
In a retrospective cohort study, the researchers used data of 27 279 patients with type 2 diabetes and stage 5 CKD or ESKD from the National Health Insurance Research Database of Taiwan. They compared treatment with GLP-1 receptor agonists (n= 701) and treatment with DPP-4 inhibitors (n= 26 578). The researchers further compared all-cause mortality, sepsis- and infection-related mortality, and mortality related to major adverse cardiovascular and cerebrovascular events between patients treated with GLP-1 receptor agonists and patients treated with DPP-4 inhibitors. They used propensity score weighting to mitigate the imbalance among covariates between the groups.
Key findings of the study:
After weighting, the researchers found that the use of GLP-1 receptor agonists was associated with lower all-cause mortality (hazard ratio [HR], 0.79) and lower sepsis- and infection-related mortality (HR, 0.61).
Upon subgroup analysis, they observed a lower risk of mortality associated with the use of GLP-1 receptor agonists compared with DDP-4 inhibitors among patients with cerebrovascular disease (HR, 0.33) than among those without the cerebrovascular disease (HR, 0.89).
The authors concluded, "Treatment with GLP-1 receptor agonists was associated with lower all-cause mortality among patients with type 2 diabetes, advanced-stage CKD, and ESKD than was treatment with DPP-4 inhibitors. Additional well-designed, prospective studies are needed to confirm the potential benefit of GLP-1 receptor agonist treatment for patients with advanced CKD or ESKD."
For further information:
DOI: 10.1001/jamanetworkopen.2022.1169
Keywords: CKD, ESKD, GLP-1 receptor agonist, DPP-4 inhibitors, type 2 diabetes, JAMA Network Open, chronic kidney disease, end-stage kidney disease, National Health Insurance Research Database of Taiwan, MACCE, Mortality rate.