Glp-1 receptor agonists and cardiovascular outcomes in obese patients on dialysis:insights –from the TriNetX real-world database

Introduction Glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated weight reduction and improvement in cardiovascular outcomes in patients with obesity regardless of the presence of diabetes. However, little is known about its effects among patients with end-stage chronic kidney disease (CKD). This study aims to determine whether the administration of these analogs in patients with obesity and CKD on dialysis results in a reduction of cardiovascular events. Objective To evaluate, utilizing real-world data, whether the use of GLP-1 receptor agonists and dual agonists is associated with a reduction in cardiovascular events and all-cause mortality in obese patients with end-stage CKD on dialysis. METHODOLOGY: We conducted a retrospective cohort analysis using the TriNetX Global Health Research Network via anonymized electronic medical records. We identified adult patients (≥18 years) with overweight or obesity (Body Mass Index (BMI) ≥ 27 kg/m²) and dialysis-dependent CKD, categorized into those treated with (exposure group) or without (control group) GLP-1 receptor agonists and dual agonists. Patients with diabetes, priorbariatric surgery or kidney transplantation were excluded. . Users of GLP-1 and dual agonists were matched to the reference cohort (non-users) using propensity score matching. The primary outcome was a composite of all-cause mortality, myocardial infarction (MI), or stroke. Results After propensity score matching, the final cohort comprised 3,136 patients monitored over median a 10-year follow-up period. The use of GLP-1 and dual agonists was associated with reduction in the of composite of death, MI, or stroke) compared to the reference group (HR 0.47; 95% CI 0.39–0.57). In secondary analyses, the benefits were statistically significant for all-cause mortality (HR 0.34; 95% CI 0.26–0.43) and MI (HR 0.56; 95% CI 0.38–0.82) componentes, but not for. stroke (HR 0.94; 95% CI 0.61–1.43). Conclusion In obese patients with CKD on dialysis, the use of GLP-1 and dual agonists was associated with a reduction in major cardiovascular events and all-cause mortality. These findings suggest that these therapies may provide substantial cardioprotective benefits in this high-risk population. Randomzied studies to confirm our findings in this populaiton are warranted.