Academic Journal
Cardiovascular Outcomes among New Users of GLP-1 Receptor Agonists Compared with DPP-4 Inhibitors and Sulfonylureas in Kidney Failure.
| Τίτλος: | Cardiovascular Outcomes among New Users of GLP-1 Receptor Agonists Compared with DPP-4 Inhibitors and Sulfonylureas in Kidney Failure. |
|---|---|
| Συγγραφείς: | Catanese B; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina., Miller C; Department of Medicine, Duke University School of Medicine, Durham, North Carolina., Wolf M; Weill Department of Medicine, Weill Cornell Medicine, New York, New York., Edmonston D; Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina. |
| Πηγή: | Journal of the American Society of Nephrology : JASN [J Am Soc Nephrol] 2026 Sep 01; Vol. 37 (9), pp. 1992-2003. Date of Electronic Publication: 2026 Mar 12. |
| Τύπος έκδοσης: | Journal Article; Comparative Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Wolters Kluwer Health, on behalf of the American Society of Nephrology Country of Publication: United States NLM ID: 9013836 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1533-3450 (Electronic) Linking ISSN: 10466673 NLM ISO Abbreviation: J Am Soc Nephrol Subsets: MEDLINE |
| Imprint Name(s): | Publication: 2023- : Hagerstown, MD : Wolters Kluwer Health, on behalf of the American Society of Nephrology Original Publication: Baltimore, MD : Williams & Wilkins, c1990- |
| Ιατρικοί όροι (MeSH): | Dipeptidyl-Peptidase IV Inhibitors*/therapeutic use , Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/complications , Sulfonylurea Compounds*/therapeutic use , Cardiovascular Diseases*/prevention & control , Cardiovascular Diseases*/epidemiology , Cardiovascular Diseases*/etiology , Cardiovascular Diseases*/mortality , Hypoglycemic Agents*/therapeutic use , Renal Insufficiency*/complications , Kidney Failure, Chronic*/complications , Glucagon-Like Peptide-1 Receptor Agonists*, United States/epidemiology ; Hospitalization/statistics & numerical data ; Humans ; Male ; Female ; Aged ; Heart Failure ; Aged, 80 and over |
| Περίληψη: | Key Points: Glucagon-like peptide-1 receptor agonists are increasingly used in patients with kidney failure despite trial exclusion. Initiation was associated with a 13% lower risk of cardiovascular events and 17% lower mortality versus dipeptidyl peptidase-4 inhibitors. Initiation was associated with a 10% lower risk of heart failure hospitalization versus dipeptidyl peptidase-4 inhibitors. Background: Few therapies improve cardiovascular outcomes for people with kidney failure. Glucagon-like peptide-1 receptor agonists (GLP-1 RA) reduce cardiovascular risk in patients with non-dialysis-dependent CKD, but the cardiovascular benefits in patients with kidney failure remain uncertain. The objective of this study was to compare cardiovascular outcomes among patients with kidney failure and type 2 diabetes newly initiated on GLP-1 RA versus other antiglycemic agents. Methods: We analyzed electronic health records, Medicare claims, and Part D data from the United States Renal Data System (2011-2021) to identify new users of GLP-1 RA ( n =3629), dipeptidyl peptidase-4 inhibitors (DPP4i; n =21,369), and sulfonylureas ( n =32,296) among patients with type 2 diabetes receiving maintenance dialysis. For the primary analysis, we performed 1:1 propensity score matching of GLP-1 RA to DPP4i initiators using 61 covariates. A prespecified secondary analysis compared propensity score-matched initiators of GLP-1 RA and sulfonylureas. The primary outcome was a modified major adverse cardiovascular event (MACE) composite of myocardial infarction, stroke, or all-cause mortality. Secondary outcomes included the individual components of the primary outcome and hospitalizations for heart failure. Cause-specific Cox models were used to estimate hazard ratios (HRs). Results: Among 3284 matched pairs of GLP-1 RA and DPP4i initiators, GLP-1 RA use was associated with lower risks of MACE (HR, 0.87; 95% confidence interval [CI], 0.78 to 0.97), all-cause mortality (HR, 0.83; 95% CI, 0.74 to 0.94), and heart failure hospitalization (HR, 0.90; 95% CI, 0.83 to 0.99) over up to 2 years of follow-up. Among 2792 matched pairs, GLP-1 RA and sulfonylurea initiators, GLP-1 RA was associated with lower risks of MACE (HR, 0.83; 95% CI, 0.74 to 0.93) and all-cause mortality (HR, 0.80; 95% CI, 0.69 to 0.91). Conclusions: Among patients with type 2 diabetes receiving maintenance dialysis, GLP-1 RA initiation was associated with lower risk of cardiovascular events and all-cause mortality compared with other commonly prescribed antiglycemic agents. Podcast: This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/JASN/2026_06_12_ASN0000001061.mp3. (Copyright © 2026 by the American Society of Nephrology.) |
| References: | J Stat Softw. 2010;33(1):1-22. (PMID: 20808728) N Engl J Med. 2009 Apr 2;360(14):1395-407. (PMID: 19332456) Cardiovasc Diabetol. 2022 Oct 3;21(1):200. (PMID: 36199064) Curr Pharm Des. 2014;20(37):5829-33. (PMID: 24533939) N Engl J Med. 2019 Jun 13;380(24):2295-2306. (PMID: 30990260) J Am Coll Cardiol. 2024 Oct 22;84(17):1615-1628. (PMID: 39217553) J Am Heart Assoc. 2016 Aug 04;5(8):. (PMID: 27491836) Circulation. 2021 Mar 16;143(11):1157-1172. (PMID: 33720773) Nephrol Dial Transplant. 2025 Feb 04;40(2):371-384. (PMID: 38986509) Lancet. 2014 May 24;383(9931):1831-43. (PMID: 24856028) Clin Pharmacokinet. 2017 Nov;56(11):1381-1390. (PMID: 28349386) N Engl J Med. 2005 Jul 21;353(3):238-48. (PMID: 16034009) J Am Heart Assoc. 2024 Feb 20;13(4):e032463. (PMID: 38362889) N Engl J Med. 2020 Oct 8;383(15):1436-1446. (PMID: 32970396) Am J Nephrol. 2022;53(1):32-40. (PMID: 35016183) Kidney Int Rep. 2019 Mar 28;4(6):864-872. (PMID: 31194073) Diabetes Care. 2016 Feb;39(2):206-13. (PMID: 26283739) Circulation. 2022 Dec 13;146(24):1882-1894. (PMID: 36508493) JAMA Netw Open. 2024 Sep 3;7(9):e2433326. (PMID: 39269703) Diabetes Care. 2025 May 1;48(5):846-859. (PMID: 40156846) N Engl J Med. 2023 Jan 12;388(2):117-127. (PMID: 36331190) J Am Heart Assoc. 2020 Jan 7;9(1):e012940. (PMID: 31902326) J Clin Invest. 2025 Nov 3;135(21):. (PMID: 41178710) J Card Fail. 2023 Jan;29(1):87-107. (PMID: 36243339) N Engl J Med. 2020 Dec 03;383(23):2219-2229. (PMID: 33264825) N Engl J Med. 2024 Jul 11;391(2):109-121. (PMID: 38785209) Eur Heart J. 2019 Mar 14;40(11):880-886. (PMID: 28431138) JAMA Netw Open. 2022 Mar 01;5(3):e221169. (PMID: 35254430) Circ Res. 2022 Mar 4;130(5):694-707. (PMID: 35100822) Am J Prev Cardiol. 2024 May 07;18:100679. (PMID: 38779187) Clin J Am Soc Nephrol. 2025 Jun 17;20(8):1100-1110. (PMID: 40526425) |
| Grant Information: | TL1 DK139567 United States DK NIDDK NIH HHS; U2C DK133491 United States DK NIDDK NIH HHS; School of Medicine, Duke University |
| Contributed Indexing: | Keywords: ESKD; GLP-1 receptor agonists; cardiovascular disease; cardiovascular events; diabetes mellitus; heart failure |
| Substance Nomenclature: | 0 (Glucagon-Like Peptide-1 Receptor Agonists) 0 (Dipeptidyl-Peptidase IV Inhibitors) 0 (Sulfonylurea Compounds) 0 (Hypoglycemic Agents) |
| Entry Date(s): | Date Created: 20260312 Date Completed: 20260901 Latest Revision: 20260913 |
| Update Code: | 20260913 |
| PubMed Central ID: | PMC13240616 |
| DOI: | 10.1681/ASN.0000001061 |
| PMID: | 41817629 |
| Βάση Δεδομένων: | MEDLINE |
καταχωρήστε σχόλιο πρώτοι!