GLP-1 receptor and cardiovascular outcomes among patients with diabetes on dialysis:– insights from the TriNetX real-world database

Introduction Although glucagon-like peptide-1 (GLP-1) receptor agonists have demonstrated efficacy in reducing major adverse cardiovascular events (MACE) and mortality in patients with diabetes, little is known about their effects in patients with end-stage chronic kidney disease (CKD). This study aims to determine whether the administration of these analogs in patients with diabetes and CKD on dialysis results in a reduction of cardiovascular events. Objective To evaluate, utilizing real-world data, whether the use of GLP-1 and dual agonists is associated with a reduction in cardiovascular events and all-cause mortality in diabetic patients with CKD on dialysis. Methodology: We performed a retrospective cohort analysis using the TriNetX Global Health Research Network through anonymized electronic medical records. We identified all patients ≥ 18 years old diagnosed with diabetes mellitus and dialysis-dependent CKD who were either treated without (control group) or with GLP-1 receptor agonists and dual agonists. Patients who underwent bariatric surgery or kidney transplantation were excluded Patients who used GLP-1 agonists and dual agonists were matched to the reference cohort (those who did not use GLP-1 and dual agonists) using propensity score matching. The primary outcomes evaluated were the composite of death, myocardial infarction (MI), or stroke. The follow-up time was 10 years. Results After propensity score matching, 46,166 patients were included in the cohorts (reference versus GLP-1 and dual agonists) with 10 years of follow-up. In the assessment of the composite outcome (death, MI, or stroke), the use of GLP-1 agonists and dual agonists was associated with risk reduction (HR 0.74; 95% CI: 0.71-0.76) compared with the control group. In individual analyses, a significant reduction was observed for all-cause mortality (HR 0.62; 95% CI: 0.59-0.65), and MI (HR 0.78; 95% CI: 0.74-0.82) components. Conversely, there was no reduction in the risk of stroke (HR 0.98; 95% CI: 0.92-1.04). Conclusion In patients with diabetes and 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. Randomized trials to confirm our fidnings in this population are warranted.