Glucagon-Like Peptide-1 Receptor Agonist Use and Risks of Hospitalization and Mortality in Patients with ESKD

KEY POINTS: Glucagon-like peptide-1 receptor agonist have shown clinical benefits in patients with chronic kidney disease, but there are no randomized trials to support their efficacy in ESKD. This matched retrospective cohort study used electronic health record from a dialysis provider and was conducted in diabetic, incident in-center hemodialysis patients. Results indicated that continued use of glucagon-like peptide-1 receptor agonist is associated with a 9% lower hospitalization and a 17% lower mortality rate. BACKGROUND: The recent clinical trial FLOW showed that semaglutide, a glucagon-like peptide-1 receptor agonist (GLP-1 RA), reduced the risk of clinical outcomes and death from cardiovascular causes in patients with CKD and type 2 diabetes. Given the substantial benefit to patients with CKD, the question remains whether these drugs benefit patients with ESKD. We sought to evaluate the impact of GLP-1 RA use in patients with incident ESKD on clinical outcomes. METHODS: Patients included in this matched retrospective cohort study were adult patients with ESKD who initiated thrice-weekly in-center hemodialysis at a kidney care organization between January 2018 and April 2024. Using internal electronic health record data, eligible patients who initiated dialysis on a GLP-1 RA (with evidence of a GLP-1 RA prescription in the first 30 days after dialysis initiation; n =2492) were matched 1:1 to those not on a prescription. Patients were followed from index date until death or the end of the study (July 31, 2024). Incident rate ratios were estimated using a negative binomial distribution with a random intercept to account for the matched nature of the data. RESULTS: Patients with a GLP-1 RA prescription in the first month of dialysis had a mean±SD age of 63±12 years and were predominately male (59%). Compared with other eligible dialysis patients, nearly all patients on a GLP-1 RA had a known diagnosis of diabetes (98% versus 73%), a majority had evidence of predialysis nephrology care (76% versus 67%), were of White race (46% versus 39%), and had a mean±SD body mass index of 33±8 kg/m 2 (versus 30±8). After matching and adjustment, GLP-1 RAs were independently associated with lower hospitalization (incidence rate ratios, 0.91 [0.87 to 0.96]) and mortality (Incidence rate ratios, 0.83 [0.73 to 0.95]) rates. CONCLUSIONS: Among incident in-center hemodialysis patients, GLP-1 RA use was independently associated with a 9% lower hospitalization rate and a 17% lower mortality rate.