Survival benefits of glucose-lowering therapies in advanced kidney disease remain uncertain, particularly in the absence of randomized trial data. A study published in Diabetology reports that initiation of GLP-1 RA is associated with improved survival in patients with T2DM and reduced kidney function.

The study analyzed administrative data from 1,188,052 U.S. Veterans with T2DM as of January 1, 2020, with follow-up through December 31, 2023. Among 31,676 individuals who met inclusion criteria, initiation of GLP-1 RA therapy was treated as a time-dependent exposure. During follow-up, 6.1% initiated GLP-1 RA therapy, and 57.7% of the cohort died. Older age and eGFR <15 mL/min/1.73 m² were associated with lower likelihood of GLP-1 RA initiation, whereas younger age and lower comorbidity burden were associated with reduced mortality after multivariable adjustment.

GLP-1 RA initiation was associated with significantly longer survival among individuals with eGFR <25 mL/min/1.73 m². This association remained consistent in those receiving KRT and in participants with eGFR 15–24 mL/min/1.73 m² who were not on KRT. In contrast, no survival benefit was observed among individuals with eGFR ≤15 mL/min/1.73 m².

These findings suggest that GLP-1RAs may confer a survival advantage in T2DM across a broad spectrum of advanced kidney disease, including patients receiving KRT. The absence of benefit at the lowest eGFR range highlights the need for targeted randomized trials to define the optimal role of GLP-1 RAs in advance-stage kidney disease.