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GLP-1 Agonists Protected Kidneys in T2D With Advanced DKD

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Researchers Studies included in this summary It is posted on Research Square as a preprint that has not yet been peer-reviewed.

important point

  • Patients with advanced diabetic kidney disease (DKD; estimated glomerular filtration rate) [eGFR] < 30mL/min/1.73m2), treatment with a glucagon-like peptide-1 (GLP-1) agonist had a neutral effect on cardiovascular outcomes, whereas propensity score-matched retrospective analyzes of more observational data showed that renal function was significantly associated with improved maintenance and survival in 2000 type 2 diabetes in Taiwan.

Why this matters

  • Cardiovascular disease is the leading cause of death in people with type 2 diabetes and diabetes. chronic kidney disease.

  • GLP-1 agonists reduce all-cause mortality and cardiovascular death in patients with type 2 diabetes, but their role in patients with advanced DKD is controversial.

  • Studies on the effects of GLP-1 agonists on cardiovascular outcomes in patients with advanced DKD are limited. Trials evaluating her GLP-1 agonist in type 2 diabetes generally excluded patients with advanced her DKD and those with end-stage renal disease (eGFR <30 mL/min/1.73m2).

  • Treatment with a GLP-1 agonist is associated with type 2 diabetes and relatively good renal function (eGFR > 30 mL/min/1.73m2), but among people with type 2 diabetes and low levels of renal function, studies have shown neutral composite cardiovascular outcome levels. or contain a limited sample of patients.

research design

  • A retrospective analysis of observational data from approximately 9000 individuals with type 2 diabetes and eGFR < 30 mL/min/1.73m in Taiwan2 Received their first prescription for a GLP-1 agonist or dipeptidyl peptidase 4 (DPP-4) inhibitor between 2012 and 2021 and had the data required for this analysis on record.

  • Data were from Taiwan’s largest multi-institutional electronic medical records database, containing information on 2 medical centers and 5 general hospitals and over 11 million patients from 2001 to 2019.

  • The researchers used propensity scoring to match 602 treated with GLP-1 agonists and 1479 treated with DPP-4 inhibitors.

Main results

  • During a mean follow-up of 2.1 years, the composite cardiovascular outcome (cardiovascular death, myocardial infarction, and ischemic stroke) were not significantly different between the GLP-1 agonist and DPP-4 inhibitor groups, with incidence rates of 13.0% and 13.8%, respectively, and a hazard ratio of 0.88, which was not significant. The proportions of each of the three components of the composite endpoint were also not significantly different between the two groups.

  • Dialysis-induced progression to end-stage renal disease was significantly lower in patients treated with GLP-1 agonists compared with DPP-4 inhibitors, with an incidence of 23.4% and 27.5%, respectively, with a significant hazard ratio of 0.72. was.

  • The incidence of >50% decline in eGFR from baseline was 32.2% with GLP-1 agonist treatment compared with 35.9% with DPP-4 inhibitors, with a significant hazard ratio of 0.74.

  • The median time to patients requiring new dialysis was 1.9 years with GLP-1 agonist treatment and 1.3 years with DPP-4 inhibitor treatment, which was significantly different.

  • All-cause mortality was 18.4% with GLP-1 agonist treatment compared to 25.1% with DPP-4 inhibitor treatment, with a significant hazard ratio of 0.71.

Limitations

  • As this study is a retrospective analysis of observational data, causality cannot be proven.

  • This study may be subject to residual confounding despite concordance in propensity scores.

  • Data were obtained from health records that may contain coding errors.

  • Treatment compliance was unknown.

Disclosure

this is, preprint research study, “Cardiovascular and Renal Effects of Glucagon-like Peptide 1 Receptor Agonists in Patients with Advanced Diabetic Kidney Disease,” by Taiwanese investigators at Research Square, provided by Medscape. This study has not yet been peer-reviewed. Read the full survey at researchsquare.com.

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