Abstract 4351238: Use of GLP-1 is Associated with Improvement in Mortality Rates in ESKD Patients

Abstract

Background: In a recent clinical trial, Semaglutide, a GLP-1 agonist, reduced the risk of clinical outcomes and death from cardiovascular causes in patients with chronic kidney disease (CKD) and type 2 diabetes (Perkovic 2024 NEJM ). Given the substantial benefit to patients with CKD, the question remains whether, and to what extent, these drugs benefit patients with end-stage kidney disease (ESKD). In this analysis, we sought to evaluate the impact of GLP-1 agonist use in incident ESKD patients on mortality. Methods: Patients included in this analysis were adult ESKD patients who initiated 3x weekly in-center hemodialysis (ICHD) at a kidney care organization between Jan 1, 2018 and Apr 15, 2024. Using internal EHR data, eligible patients who initiated dialysis on a GLP-1a (with a GLP-1a prescription in the first 30 days after dialysis initiation; n=2,492) were matched 1:1 to those not on a prescription. Matching factors included weight, index date, evidence of predialysis nephrology care, a diabetes diagnosis, and use of diabetes medications during the first 30 days of dialysis. Patients were followed from index date until death or the end of the study (Jul 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 filling GLP-1a prescriptions in the first month of dialysis were on average 63 years old and predominately male (59%). Compared to other eligible dialysis patients, nearly all patients on a GLP-1a have a known diagnosis of diabetes (98% vs. 73%), a majority have evidence of predialysis nephrology care (76% vs. 67%), are White (46% vs. 39%), and have a mean BMI of 33 (vs. 30). Results indicate that after matching and adjustment for age, race, and dual eligibility, GLP-1s are independently associated with a reduction in mortality [IRR: 0.83 (0.73, 0.95)]. Conclusions: Results indicate that in the context of known diabetic, incident ICHD patients, continued GLP-1a use is independently associated with a 17% reduction in mortality.