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

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. There is limited real-world data evaluating outcomes of glucagon-like peptide-1 receptor agonists (GLP1-RA) use in patients with moderate to advanced CKD. Here, emulating a clinical trial, the authors show that GLP1-RA use in patients with CKD is associated with lower rate of acute healthcare utilization, all-cause death and kidney events compared to DPP4i.