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Comparative cardiovascular effectiveness of GLP-1RAs versus DPP-4is in dialysis patients with type 2 diabetes: a

Hiroki Shimada1, Toshiki Fukasawa1, Kayoko Mizuno1

  • 1Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyo-ku, Kyoto 606-8501, Japan.

Diabetes & Metabolism
|April 13, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) may lower cardiovascular event risk in type 2 diabetes patients on dialysis compared to DPP-4 inhibitors. Further trials are needed to confirm these findings for clinical practice.

Area of Science:

  • Cardiology
  • Endocrinology
  • Nephrology

Background:

  • Patients with type 2 diabetes (T2D) on dialysis face high cardiovascular event risks.
  • Limited evidence exists on the cardiovascular effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in this high-risk group.

Purpose of the Study:

  • To assess the cardiovascular effectiveness of GLP-1RAs versus DPP-4 inhibitors in patients with T2D undergoing maintenance dialysis.
  • To emulate a target trial using a Japanese administrative claims database.

Main Methods:

  • A cohort study included T2D patients on maintenance dialysis initiating GLP-1RAs or DPP-4 inhibitors (April 2015-March 2023).
  • The primary outcome was the 3-year risk of major adverse cardiovascular events (MACE): acute myocardial infarction, stroke, or cardiovascular death.
  • Inverse probability weighting was used to adjust for baseline and time-varying confounders.

Main Results:

  • The 3-year MACE risk was 29.7% for GLP-1RA users and 37.6% for DPP-4i users.
  • GLP-1RA use was associated with a risk difference of -8.0% (95% CI, -15.5% to 0.9%) and a risk ratio of 0.79 (95% CI, 0.59 to 1.03).

Conclusions:

  • Sustained use of GLP-1RAs may reduce MACE risk in T2D patients on dialysis compared to DPP-4 inhibitors.
  • These findings suggest a potential cardiovascular benefit, but require confirmation through randomized controlled trials.
Keywords:
DiabetesDipeptidyl peptidase-4 inhibitorsEnd-stage kidney diseaseGlucagon-like peptide-1 receptor agonistsMajor adverse cardiovascular eventsTarget trial emulation

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