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Healthcare utilization, mortality, and cardiovascular events following GLP1-RA initiation in chronic kidney disease

Shuyao Zhang1, Fnu Sidra1,2, Carlos A Alvarez3

  • 1Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

Nature Communications
|December 5, 2024
PubMed

Insights

Glucagon-like peptide-1 receptor agonists (GLP1-RA) use in type 2 diabetes patients with chronic kidney disease (CKD) was linked to reduced healthcare use and mortality. Cardiovascular events showed no significant difference between GLP1-RA and other treatments.

Area of Science:

  • Nephrology
  • Endocrinology
  • Health Services Research

Background:

  • Glucagon-like peptide-1 receptor agonists (GLP1-RA) show potential in slowing chronic kidney disease (CKD) progression and reducing cardiovascular events in type 2 diabetes (T2D) patients.
  • However, real-world data on their impact on healthcare utilization and mortality in T2D with moderate to advanced CKD is limited.

Purpose of the Study:

  • To compare the real-world effects of GLP1-RA versus Dipeptidyl peptidase-4 inhibitors (DPP4i) on healthcare utilization, mortality, and cardiovascular events in U.S. veterans with moderate to advanced CKD.
  • To emulate a clinical trial design for robust outcome assessment.

Main Methods:

  • A retrospective cohort study emulating a clinical trial was conducted using U.S. veteran data from fiscal years 2006-2021.
  • Patients aged 35+ with moderate to advanced CKD initiating GLP1-RA or DPP4i were included.
  • Propensity score matching created 16,076 comparable pairs, with a mean follow-up of 2.2 years.

Main Results:

  • GLP1-RA initiation was associated with a significantly lower annual rate of acute healthcare utilization compared to DPP4i.
  • All-cause mortality was also significantly lower in the GLP1-RA group.
  • No significant difference was observed in the rate of acute cardiovascular events between the two treatment groups.

Conclusions:

  • In U.S. veterans with moderate to advanced CKD and T2D, GLP1-RA use is associated with reduced acute healthcare utilization and lower all-cause mortality compared to DPP4i.
  • GLP1-RA may be a beneficial treatment option for managing T2D in patients with CKD, impacting healthcare resource use and survival.
  • Further research may explore specific mechanisms driving these utilization and mortality benefits.

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