SGLT2 inhibitors match GLP-1 drugs for overall kidney outcomes
In older veterans, primary kidney and survival risks matched with a hazard ratio of 1.00, though SGLT2 inhibitors showed lower sustained kidney decline and end-stage disease.
Clinical Journal of the American Society of Nephrology
The observational study evaluated 28,365 GLP-1RA and 78,354 SGLT2i initiators among US Veterans aged 65 years and older with type 2 diabetes and chronic kidney disease stages 3 to 4. Researchers compared nephroprotective outcomes between 2016 and 2025 across a median follow-up of 11 months, balancing treatment groups with propensity score matching weights. Over this period, the weighted risk for the primary outcome was similar between GLP-1RA and SGLT2i initiators, showing a hazard ratio of 1.00 and a rate difference of 0.0002 per 1,000 person-years, driven largely by similar all-cause mortality. However, GLP-1RA initiators had higher risks of sustained kidney function decline and end-stage kidney disease. These associations were consistent across baseline kidney disease stages, history of cardiovascular disease, body mass index, and glycated hemoglobin levels.
Why it matters
Chronic kidney disease and metabolic dysfunction are major contributors to multi-organ vulnerability in older adults. Comparing real-world outcomes of common therapies helps determine how targeted metabolic interventions affect organ-specific decline during aging.
Caveats
The study is observational and reflects health system records from a U.S. Veteran cohort followed for a relatively short median duration of 11 months.
The paper
Comparative Renal Effectiveness of GLP-1RA and SGLT2i in US Veterans with Type 2 Diabetes and CKD
Brigham and Women's Hospital
Clinical Journal of the American Society of Nephrology · 29 Sep 2026