Patients with type 2 diabetes mellitus (T2DM) receiving dialysis face a substantial burden of cardiovascular disease and premature mortality, yet evidence supporting glucose-lowering therapies in this population remains limited. A study published in Clinical Kidney Journal evaluated cardiovascular and clinical outcomes associated with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in patients undergoing dialysis.

This retrospective propensity score-matched cohort study used data from the TriNetX US Collaborative Network between 2013 and 2022. The analysis included 1,688 matched pairs of new GLP-1 receptor agonist and dipeptidyl peptidase-4 (DPP-4) inhibitor users with T2DM receiving dialysis. The primary outcome was major adverse cardiovascular events (MACE), while secondary outcomes included all-cause mortality, heart failure, sepsis, hospitalization, and emergency department visits.

Findings

• GLP-1 receptor agonist use was associated with a lower risk of MACE than DPP-4 inhibitor use (hazard ratio [HR], 0.88; 95% CI, 0.78-0.99).
• All-cause mortality risk was lower among GLP-1 receptor agonist users (HR, 0.84; 95% CI, 0.72-0.99).
• Risks of myocardial infarction (HR, 0.84; 95% CI, 0.70-0.99) and heart failure (HR, 0.87; 95% CI, 0.78-0.98) were reduced with GLP-1 receptor agonists.
• GLP-1 receptor agonist therapy was associated with a lower risk of sepsis (HR, 0.81; 95% CI, 0.71-0.92).
• Hospitalizations and emergency department visits occurred less frequently among GLP-1 receptor agonist users.
• Results remained consistent across sensitivity and subgroup analyses.

This real-world study found that GLP-1 receptor agonist use was associated with lower risks of cardiovascular events, mortality, sepsis, and healthcare utilization than DPP-4 inhibitor use in patients with T2DM receiving dialysis. The findings support further evaluation of GLP-1 receptor agonists in this high-risk population.