GLP-1RAs are linked to reduced risk for serious renal events vs DPP-4is

  • Pasternak B & al.
  • Diabetes Care
  • 15 Apr 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are associated with lower risk for serious renal events compared with dipeptidyl peptidase-4 inhibitors (DPP-4is).

Why this matters

  • Patients with type 2 diabetes are at high risk for chronic kidney disease and end-stage renal disease.

Study design

  • Data from nationwide Swedish, Danish, and Norwegian registers covering 2010-2016 for 38,731 new GLP-1RA users matched 1:1 by age, sex, and propensity score to new DPP-4i users.
  • Mean follow-up: 3.0 years.
  • Primary outcome: composite including renal replacement therapy, death from renal causes, hospitalization for renal events.
  • Funding: individual author funding.

Key results

  • Primary outcome occurred in 570 with GLP-1RAs vs 722 with DPP-4is.
    • Incidence rates (IRs): 4.8 vs 6.3 events/1000 person-years.
    • HR: 0.76 (95% CI, 0.68-0.85).
  • Risk reduction seen primarily in first 2 years: HR, 0.68 (95% CI, 0.54-0.85).
  • GLP-1RAs vs DPP-4is were associated with significantly lower risks for:
    • Renal replacement therapy:
      • IR: 1.9 vs 2.5 per 1000 person-years;
      • HR: 0.73 (95% CI, 0.62-0.87).
    • Hospitalization for renal events:
      • IR: 3.7 vs 5.1 per 1000 person-years;
      • HR: 0.73 (95% CI, 0.65-0.83).
  • GLP-1RAs vs DPP-4is were not associated with death from renal causes:
    • IR: 0.3 vs 0.4 per 1000 person-years;
    • HR: 0.72 (95% CI, 0.48-1.10).

Limitations

  • Most GLP-1RAs were liraglutide.
  • Based on filled prescriptions; adherence unknown.
  • Potential residual confounding.