SGLT2 inhibitor vs GLP-1 RA: Which is better for CKD patients with diabetes?

Initiation of an SGLT2 inhibitor, relative to a GLP-1 receptor agonist (RA), results in a lower risk of adverse kidney events among patients with stage 2 diabetes and stage 4‒5 chronic kidney disease (CKD), with similar cardiovascular and mortality risks, a study has shown.

A target trial emulation design was applied in this retrospective study using the TriNetX platform. The authors enrolled adult patients with type 2 diabetes and stage 4‒5 CKD who were newly initiated on GLP-1 RA or SGLT2 inhibitor.

Participants were propensity-score matched in a 1:1 ratio. Hazard ratios (HRs) were calculated for outcomes, including major adverse kidney events (MAKE), major adverse cardiovascular events (MACE), and all-cause mortality.

Each group included 7,458 participants, with a mean estimated glomerular filtration rate of 23‒24 mL/min/1.73 m².

Compared with users of SGLT2 inhibitors, those initiated on GLP-1 RAs showed higher risks of MAKE (HR, 1.05, 95 percent confidence interval [CI], 1.0‒1.1) and dialysis (HR, 1.09, 95 percent CI, 1.03‒1.15), but similar risks of all-cause mortality (HR, 0.98, 95 percent CI, 0.91‒1.05) and MACE (HR, 0.97, 95 percent CI, 0.93‒1.01), despite a lower risk for heart failure (HR, 0.94, 95 percent CI, 0.90‒0.99).

Furthermore, men and patients without failure in the GLP-1 RA group had a higher risk of MAKE.

“Further studies are warranted to confirm these findings,” the authors said.