Glucagon-like peptide 1 receptor agonists (GLP-1RAs) may exert protective effects on kidney function and delay dialysis initiation in patients with advanced diabetic kidney disease, according to new study findings.

In a retrospective study of patients with type 2 diabetes and an estimated glomerular filtration rate (eGFR)  less than 30 mL/min/1.73 m2 (based on the Modification of Diet in Renal Disease study equation) treated from 2012 to 2021, investigators matched 602 new users of GLP-1RAs to 1479 new users of dipeptidyl peptidase 4 inhibitors (DPP-4is). GLP-1RAs included liraglutide and dulaglutide, and DPP-4is included sitagliptin, vildagliptin, saxagliptin, and linagliptin.

During a mean 2.1 years, 13% and 13.8% of the GLP-1RA and DPP-4i groups, respectively, experienced composite cardiovascular events, including cardiovascular death, myocardial infarction, and ischemic stroke. Composite kidney events occurred in 38.2% and 44.2% of the GLP-1RA and DPP-4i groups, respectively

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Compared with new use of DPP-4is, new use of GLP-1RAs did not significantly improve cardiovascular outcomes in the advanced diabetic kidney disease population. With respect to renal outcomes, the GLP-1RA group had significant 26%, 28%, and 25% lower risks of a more than 50% decline in eGFR, progression to end-stage kidney disease requiring dialysis, and a composite of these outcomes including cardiovascular death, respectively, compared with the DPP-4i group, Tien-Hsing Chen, MD, of Keelung Chang Gung Memorial Hospital in Taiwan, and colleagues reported in Cardiovascular Diabetology. The median time to dialysis initiation was significantly longer in the GLP-1RA than DPP-4i group (median 1.9 vs 1.3 years).

The GLP-1RA group also had a significant 29% lower risk of all-cause mortality and 19% lower risk of hospital admission for any cause.

According to Dr Chen’s team, “our findings showed that the use of GLP-1RAs in type 2 diabetes patients with advanced DKD resulted in a neutral cardiovascular effect, better kidney function preservation, and lower mortality.”


Lin Y, Wang TH, Tsai ML, et al. The cardiovascular and renal effects of glucagon-like peptide 1 receptor agonists in patients with advanced diabetic kidney disease. Cardiovascular Diabetology. Published online March 17, 2023. doi:10.1186/s12933-023-01793-9