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. 2024 Dec 5;15(1):10623.
doi: 10.1038/s41467-024-54009-3.

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

Shuyao Zhang  1 , Fnu Sidra  1   2 , Carlos A Alvarez  3 , Mustafa Kinaan  4   5 , Ildiko Lingvay #  1   6 , Ishak A Mansi #  7   8
Affiliations

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

Shuyao Zhang et al. Nat Commun. .

Abstract

Treatment with glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) may attenuate kidney disease progression and cardiovascular events but their real-world impact on healthcare utilization and mortality in this population are not well-defined. Here, we emulate a clinical trial that compares outcomes following initiation of GLP1-RA vs Dipeptidyl peptidase-4 inhibitors (DPP4i), as active comparators, in U.S. veterans aged 35 years of older with moderate to advanced CKD during fiscal years 2006 to 2021. Primary outcome was rate of acute healthcare utilization. Secondary outcomes were all-cause mortality and a composite of acute cardiovascular events. After propensity score matching (16,076 pairs) and 2.2 years mean follow-up duration, use of GLP1-RA in patients with moderate to advanced CKD was associated with lower annual rate of acute healthcare utilization and all-cause mortality. There was no significant difference in acute cardiovascular events.

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Conflict of interest statement

Competing interests: I.L. received research funding (paid to institution) from NovoNordisk, Sanofi, Merck, Pfizer, Mylan, Boehringer-Ingelheim. IL received advisory/consulting fees and/or other support from: Novo Nordisk, Eli Lilly, Sanofi, Astra Zeneca, Boehringer-Ingelheim, Cytoki Pharma, Johnson and Johnson, Intercept, TARGETPharma, Merck, Pfizer, Valeritas, Zealand Pharma, Shionogi, Carmot Therapeutics, Structure Therapeutics, Bayer, Translational Medical Academy, Mediflix, Biomea, Metsera, Regeneron, The Comm Group, and WebMD. I.L. serves on the Data Safety Monitoring Board for JAEB. C.A.A. received research funding (paid to the institution) from Merck, Bristol Myers Squibb, and Boehringer-Ingelheim. C.A.A. received funding from the National Institutes of Health National Center for Advancing Translational Sciences (grant #UL1TR003163). S.Z., F.S. and I.A.M. declared no conflict of interest.

Figures

Fig. 1
Fig. 1. Flow chart of patient selection and final study sample.
CKD chronic kidney disease, GLP1-RA glucagon like peptide 1 receptor agonists, DPP4i dipeptidyl peptidase 4 inhibitors, VA veteran affairs.
Fig. 2
Fig. 2. Kaplan-Meier curves for all-cause mortality and first composite cardiovascular event.
Panel 2A: Kaplan–Meier curves for time to all-cause mortality (HR: 0.86, 95%CI: 0.81–0.90); and Panel 2B: Kaplan–Meier curves for cardiovascular events (HR: 0.99, 95%CI: 0.93–1.06). CI confidence interval, DPP4i dipeptidyl peptidase 4 inhibitors, GLP1-RA glucagon like peptide 1 receptor agonists, HR hazard ratio, K-M Kaplan-Meier failure estimates.
See this image and copyright information in PMC

References

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