Outcomes in New User Cohorts of SGLT2 Inhibitors or GLP-1 Receptor Agonists with Type 2 Diabetes and Chronic Kidney
J Bradley Layton1, Ryan Ziemiecki1, Catherine B Johannes2
1RTI Health Solutions, Research Triangle Park, NC, USA.
Introduction:
People with chronic kidney disease (CKD) and type 2 diabetes (T2D) have an increased risk of kidney failure and cardiovascular disease. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) have shown cardiorenal protective effects. The objective of this multinational, multidatabase study was to describe the incidence of kidney and cardiovascular outcomes in separate, non-mutually exclusive cohorts of patients with CKD and T2D who initiated either an SGLT2i or a GLP-1 RA.
Methods:
Data describing adults (≥ 18 years) with T2D and CKD who were new users of either SGLT2i or GLP-1 RA from 2012 to 2019 were assessed from population-based Danish National Health Registers (DNHR) and Valencia Health System Integrated Database (VID), hospital-based Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex), and US Optum® de-identified Electronic Health Record dataset (Optum® EHR). Crude incidence rates (IRs) and 95% confidence intervals (CIs) for primary outcomes (kidney failure, acute coronary syndrome, stroke, new-onset congestive heart failure, new-onset atrial fibrillation) and cumulative incidence by follow-up time for primary and secondary outcomes (laboratory measurements of kidney function) were estimated.
Results:
SGLT2i cohorts comprised 12,501 patients in DNHR, 22,404 in VID, 811 in J-CKD-DB-Ex, and 54,308 in Optum® EHR. GLP-1 RA cohorts comprised 10,696 in DNHR, 8317 in VID, 219 in J-CKD-DB-Ex, and 78,934 in Optum® EHR. Baseline clinical profile differences were observed for GLP-1 RA and SGLT2i new users, and crude IRs of kidney and heart failure tended to be higher in the GLP-1 RA cohorts than in the SGLT2i cohorts across data sources.
Conclusion:
Understanding the incidence of kidney failure and cardiovascular outcomes in people receiving antidiabetic medications with cardiorenal protective effects is important for future studies aiming to compare the incidence of kidney and cardiovascular outcomes related to new and existing CKD treatments.
Insights
Patients with type 2 diabetes and chronic kidney disease initiating sodium-glucose cotransporter-2 inhibitors (SGLT2i) or glucagon-like peptide-1 receptor agonists (GLP-1 RA) were studied. Incidence rates for kidney and cardiovascular outcomes were described, with GLP-1 RA users showing higher rates than SGLT2i users.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) face elevated risks of kidney failure and cardiovascular disease.
- Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) are recognized for their cardiorenal protective properties.
Purpose of the Study:
- To describe the incidence of kidney and cardiovascular outcomes in patients with CKD and T2D initiating either SGLT2i or GLP-1 RA.
- To analyze these outcomes across multinational, multidatabase cohorts.
Main Methods:
- A multinational study assessed adults (≥18 years) with T2D and CKD who were new users of SGLT2i or GLP-1 RA between 2012 and 2019.
- Data sources included Danish National Health Registers, Valencia Health System Integrated Database, Japan Chronic Kidney Disease Database Extension, and US Optum EHR.
- Crude incidence rates and cumulative incidence of primary outcomes (kidney failure, acute coronary syndrome, stroke, heart failure, atrial fibrillation) and secondary outcomes (kidney function markers) were estimated.
Main Results:
- SGLT2i cohorts included 12,501-54,308 patients across databases; GLP-1 RA cohorts included 219-78,934 patients.
- Baseline clinical profiles differed between new users of GLP-1 RA and SGLT2i.
- Crude incidence rates for kidney and heart failure were generally higher in GLP-1 RA cohorts compared to SGLT2i cohorts across all data sources.
Conclusions:
- Understanding the incidence of kidney failure and cardiovascular outcomes in patients using SGLT2i or GLP-1 RA is crucial.
- This knowledge informs future research comparing CKD treatments and their associated outcomes.
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