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Cited by 25Diabetes Treatment and ManagementDialysis and Renal Disease ManagementChronic Kidney Disease and Diabetes

Mortality and cardiovascular events in diabetes mellitus patients at dialysis initiation treated with glucagon-like peptide-1 receptor agonists

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Lai, Hsuan-Wen, See, Chun Yin, Chen, Jui-Yi, Wu, Vin-Cent·2024·Cardiovascular Diabetology
DOI 10.1186/s12933-024-02364-2PMC PMC11287940
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Abstract

Background: Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) have demonstrated efficacy in improving mortality and cardiovascular (CV) outcomes. However, the impact of GLP-1RAs therapy on cardiorenal outcomes of diabetic patients at the commencement of dialysis remains unexplored. Purpose: This study aimed to investigate the long-term benefits of GLP-1RAs in type 2 diabetic patients at dialysis commencement. Methods: A cohort of type 2 diabetic patients initializing dialysis was identified from the TriNetX global database. Patients treated with GLP-1RAs and those treated with long-acting insulin (LAI) were matched by propensity score. We focused on all-cause mortality, four-point major adverse cardiovascular events (4p-MACE), and major adverse kidney events (MAKE). Results: Among 82,041 type 2 diabetic patients initializing dialysis, 2.1% ( n = 1685) patients were GLP-1RAs users (mean ages 59.3 years; 55.4% male). 1682 patients were included in the propensity-matched group, treated either with GLP-1RAs or LAI. The main causes of acute dialysis in this study were ischemic heart disease (17.2%), followed by heart failure (13.6%) and sepsis (6.5%). Following a median follow-up of 1.4 years, GLP-1RAs uses at dialysis commencement was associated with a reduced risk of mortality (hazard ratio [HR] = 0.63, p < 0.001), 4p-MACE (HR = 0.65, p < 0.001), and MAKE (HR = 0.75, p < 0.001). This association was particularly notable in long-acting GLP-1RAs users, with higher BMI, lower HbA1c, and those with eGFR > 15 ml/min/1.73m 2 . GLP-1RAs’ new use at dialysis commencement was significantly associated with a lower risk of MACE ( p = 0.047) and MAKE ( p = 0.004). Additionally, GLP-1RAs use among those who could discontinue from acute dialysis or long-term RAs users was associated with a lower risk of mortality, 4p-MACE, and MAKE. Conclusion: Given to the limitations of this observational study, use of GLP-1RAs at the onset of dialysis was associated with a decreased risk of MACE, MAKE, and all-cause mortality. These findings show the lack of harm associated with the use of GLP-1RAs in diabetic patients at the initiation of acute dialysis.

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  • This observational study had methodological issues, including the likely inclusion of individuals with AKI.

    “However, this study had methodological issues, including the likely inclusion of individuals with AKI (158).”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [158]

  • In an observational study, use of GLP-1-based therapy at the onset of dialysis was associated with a decreased risk of major cardiovascular events (adjusted HR 0.65, P < 0.001) and all-cause mortality (adjusted HR 0.63, P < 0.001) during a median follow-up of 1.4 years.

    “In an observational study, use of GLP-1-based therapy at the onset of dialysis was associated with a decreased risk of major cardiovascular events (adjusted HR 0.65, P < 0.001) and all-cause mortality (adjusted HR 0.63, P < 0.001) during a median follow-up of 1.4 years.”

    From 11. Chronic Kidney Disease and Risk Management: Standards of Care in Diabetes—2026 (2026) · cites this paper as [158]

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Authors
Lai, H.-W., See, C. Y., Chen, J.-Y., & Wu, V.-C.
Affiliations
  • Taipei Medical University (TW)
  • National Taiwan University (TW)
  • Chi Mei Medical Center (TW)
  • National Taiwan University Hospital (TW)
Corresponding author
Lai, Hsuan-Wen
ORCID
Venue
Cardiovascular Diabetology
Publisher
Springer Science and Business Media LLC
Published
2024-07-29
Volume
23
Issue
1
Pages
277-277
ISSN
1475-2840 (ISSN-L)
DOI
10.1186/s12933-024-02364-2
PMC
PMC11287940
OpenAlex
W4401135187
Cited by
25
References
38
Citations by year
2026: 10 · 2025: 11 · 2024: 4
FWCI
8.23
Type
journal article
Language
en
Update notices
correction (2024-10-14)
Open access
Licence
Locations
  • Cardiovascular Diabetology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
  • Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
Keywords
GLP-1 receptor agonists, type 2 diabetes, dialysis initiation, all-cause mortality, major adverse cardiovascular events, major adverse kidney events, long-acting insulin, cardiorenal outcomes, acute dialysis, end-stage renal disease, heart failure, ischemic heart disease, sepsis, HbA1c, EGFR, body mass index
MeSH terms
Glucagon-Like Peptide-1 Receptor, Glucagon-Like Peptide-1 Receptor Agonists, Aged, Cardiovascular Diseases, Cause of Death, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Female, Renal Dialysis, Humans, Hypoglycemic Agents, Male, Middle Aged, Retrospective Studies, Risk Factors, Time Factors, Biomarkers, Databases, Factual, Treatment Outcome, Risk Assessment, Incretins

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