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Cardiovascular Outcomes among New Users of GLP-1 Receptor Agonists Compared with DPP-4 Inhibitors and Sulfonylureas

Benjamin Catanese1,2, Cameron Miller3, Myles Wolf4

  • 1Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.

Journal of the American Society of Nephrology : JASN
|March 12, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1 RA) significantly reduced cardiovascular events and mortality in patients with type 2 diabetes on dialysis. This study highlights GLP-1 RA as a beneficial treatment option for this high-risk population.

Area of Science:

  • Nephrology
  • Cardiology
  • Endocrinology

Background:

  • Limited therapies exist to improve cardiovascular outcomes in patients with kidney failure.
  • Glucagon-like peptide-1 receptor agonists (GLP-1 RA) show cardiovascular benefits in chronic kidney disease but remain uncertain in kidney failure.
  • This study investigates GLP-1 RA's cardiovascular impact in dialysis patients with type 2 diabetes.

Purpose of the Study:

  • To compare cardiovascular outcomes in patients with kidney failure and type 2 diabetes initiating GLP-1 RA versus other antidiabetic agents.
  • To assess the efficacy of GLP-1 RA in reducing major adverse cardiovascular events (MACE) and all-cause mortality in dialysis patients.

Main Methods:

  • Analysis of electronic health records, Medicare claims, and Part D data (2011-2021).
  • Propensity score matching (1:1) comparing GLP-1 RA initiators with dipeptidyl peptidase-4 inhibitors (DPP4i) and sulfonylurea initiators.
  • Primary outcome: modified MACE (myocardial infarction, stroke, all-cause mortality); secondary outcomes: heart failure hospitalization.

Main Results:

  • GLP-1 RA initiators showed lower risks of MACE (HR 0.87) and all-cause mortality (HR 0.83) compared to DPP4i.
  • GLP-1 RA use was associated with reduced heart failure hospitalizations (HR 0.90) versus DPP4i.
  • Compared to sulfonylureas, GLP-1 RA initiators had lower risks of MACE (HR 0.83) and all-cause mortality (HR 0.80).

Conclusions:

  • GLP-1 RA initiation is linked to decreased cardiovascular events and mortality in type 2 diabetes patients undergoing maintenance dialysis.
  • GLP-1 RA demonstrates a favorable cardiovascular risk profile compared to DPP4i and sulfonylureas in this population.
  • Findings support GLP-1 RA as a valuable therapeutic option for managing cardiovascular risk in dialysis patients.
Keywords:
ESKDGLP-1 receptor agonistscardiovascular diseasecardiovascular eventsdiabetes mellitusheart failure

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