JAMA Netw Open: Association of glucagon-like peptide-1 receptor agonist versus dipeptidyl peptidase-4 inhibitor use with mortality in patients with type 2 diabetes and advanced chronic kidney disease

Background: Chronic kidney disease (CKD) and end-stage renal disease (ESKD) are contributors to health burdens and are associated with increased mortality and cardiovascular events
.

Type 2 diabetes is the most common cause of CKD, and both diabetes and end-stage renal disease are associated with increased all-cause mortality and increased infection and cardiovascular events

Chronic kidney disease (CKD) and end-stage renal disease (ESKD) are contributors to health burdens and are associated with increased mortality and cardiovascular events

At the same time, DPP-4 inhibitors are often prescribed to patients with advanced CKD or ESKD because of their safety profile and effectiveness in glycemic control,15 despite having a neutral effect on renal and cardiovascular outcomes

Methods: This retrospective cohort study used data obtained from the Taiwan National Health Insurance Research Database on patients with type 2 diabetes and stage 5 CKD or ESKD
.

The study was conducted between January 1, 2012 and December 31, 2018

Main Outcomes and Outcomes: All-cause mortality, sepsis and infection-related mortality, and mortality rates related to major adverse cardiovascular and cerebrovascular events were compared between patients treated with GLP-1 receptor agonists and those treated with DPP-4 inhibitors.
death rate
.

Propensity score weighting was used to mitigate the imbalance between covariates between groups

Results: Among the 27279 patients, 265578 patients in the DPP-4 inhibitor group (14443 males, accounting for 54.
34%; mean age 65[13] years old); 701 patients in the GLP-1 receptor agonist group (346 males, accounting for 54.
34%) 49.
36%; mean age 59[13] years)
.

After weighting, GLP-1 receptor agonist use was associated with lower all-cause mortality (hazard ratio [HR], 0.

Table 1.
Baseline characteristics of patients with diabetes and stage 5 chronic kidney disease or end-stage renal disease

Table 1.
Baseline characteristics of patients with diabetes and stage 5 chronic kidney disease or end-stage renal disease

Table 2.
Analysis of primary and secondary outcomes

Table 2.
Analysis of primary and secondary outcomes

Conclusions: In patients with type 2 diabetes, advanced CKD, and ESKD, treatment with GLP-1 receptor agonists was associated with lower all-cause mortality than patients with DPP-4 inhibitors
.

More well-designed prospective studies are needed to confirm the potential benefit of GLP-1 receptor agonists in patients with advanced CKD or ESKD

In patients with type 2 diabetes, advanced CKD, and ESKD, treatment with GLP-1 receptor agonists was associated with lower all-cause mortality than patients with DPP-4 inhibitors

Association of Glucagon-Like Peptide-1 Receptor Agonist vs Dipeptidyl Peptidase-4 Inhibitor Use With Mortality Among Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease.
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