Layton JB, Ziemiecki R, Johannes CB, Pladevall-Vila M, Khan AM, Ebert N, Kovesdy CP, Christiansen CF, Garcia-Sempere A, Kanegae H, Coleman CI, Walsh M, Andersen IT, Rodriguez-Bernal C, Cabaninas CR, Thomsen RW, Farjat AE, Gay A, Gee P, Hurtado I, Kashihara N, Munch PV, Liu F, Okami S, Yamashita S, Yano Y, Vizcaya D, Oberprieler N. Outcomes in new user cohorts of SGLT2 inhibitors or GLP-1 receptor agonists with type 2 diabetes and chronic kidney disease. Diabetes Ther. 2025 Jun 4. doi: 10.1007/s13300-025-01750-7

INTRODUCTION: People with chronic kidney disease (CKD) and type 2 diabetes (T2D) have an increased risk of kidney failure and cardiovascular disease. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and the glucagon-like peptide-1 receptor agonists (GLP-1 RA) have shown cardiorenal protective effects. The objective of this multinational, multidatabase study was to describe the incidence of kidney and cardiovascular outcomes in separate cohorts of patients with CKD and T2D who initiated an SGLT2i or a GLP-1 RA.

METHODS: Data describing adults (≥18 years) with T2D and CKD who were new users of SGLT2i or GLP-1 RA from 2012-2019 were assessed from population-based Danish National Health Registers (DNHR) and Valencia Health System Integrated Database (VID), hospital-based Japan Chronic Kidney Disease Database Extension (J-CKD-DBEx), and United States Optum® de-identified Electronic Health Record dataset (Optum® EHR). Crude incidence rates (IRs) and 95% confidence intervals (CIs) for primary outcomes (kidney failure, acute coronary syndrome, stroke, new-onset congestive heart failure, new-onset atrial fibrillation) and cumulative incidence by follow-up time for primary and secondary outcomes (laboratory measurements of kidney function) were estimated.

RESULTS: SGLT2i cohorts comprised 12,501 patients in DNHR, 22,404 in VID, 811 in JCKD- DB-Ex, and 54,308 in Optum® EHR. GLP-1 RA cohorts comprised 10,696 in DNHR, 8,317 in VID, 219 in J‑CKD-DB-Ex, and 78,934 in Optum® EHR. While cohorts were not directly statistically compared, baseline clinical profile differences were observed for GLP-1 RA versus SGLT2i new users across data sources. Common findings for primary outcomes across data sources were IRs of kidney and heart failure tended to be higher in the GLP-1 RA cohorts than in the SGLT2i cohorts.

CONCLUSION: Understanding the incidence of kidney failure and cardiovascular outcomes in people receiving antidiabetic medications with cardiorenal protective effects is important for future studies comparing the incidence of kidney and cardiovascular outcomes related to new and existing CKD treatments.