Abstract: SA-PO1159
Impact of SGLT2 Inhibitors and GLP-1 Receptor Agonists on Kidney Failure Risk Prediction
Session Information
- CKD: SGLT2 Inhibitors and GLP-1 RAs for Kidney Health
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Hartsell, Sydney Elizabeth, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Wei, Guo, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Singh, Ravinder, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Throolin, Michael J, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Nevers, Mckenna R., Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Sarwal, Amara, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Derington, Catherine G., University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Katkam, Niharika, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Akramimoghadam, Farideh, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Boucher, Robert E., Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Shen, Jincheng, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Drakos, Stavros, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Cheung, Alfred K., Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Greene, Tom, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
- Beddhu, Srinivasan, Cardio-Renal and Metabolism Center, University of Utah Health, Salt Lake City, Utah, United States
Background
The Kidney Failure Risk Equation (KFRE) is KDIGO-recommended for risk prediction to guide patient care. Whether the use of SGLT2i or GLP-1RA modify KFRE risk prediction is clinically relevant.
Methods
We performed an active comparator, new user study in a national cohort of veterans with T2D on metformin without ESKD who initiated SGLT2i, non-exendin GLP-1RA or insulin glargine (IG) from 1/1/18-12/31/21 (N=160,428). Inverse probability weighting minimized measured confounding. Age, sex, eGFR and UACR were used to calculate 5-year KFRE and define subgroups <2%, 2-<6%, ≥6%. Follow-up was until 3/31/23 for kidney failure (eGFR <15 over 2 consecutive labs, dialysis dependence or transplant by diagnostic code or USRDS linkage) and death. We examined whether study drug class modified the KFRE’s relationship to three-year cumulative incidence of kidney failure under competing risk framework.
Results
In KFRE ≥6%, kidney failure and death before kidney failure were the highest in IG, followed by GLP-1RA then SGLT2i. In KFRE 2-<6%, kidney failure incidence was highest in SGLT2i new-users, likely due to a large competing risk of death, followed by IG then GLP-1RA (Table). Visually, SGLT2i reduced kidney failure rates especially in KFRE≥6%, while GLP-1RA appeared most protective in KFRE 2-<6% (Figure).
Conclusion
SGLT2i and GLP-1RA reduced expected kidney failure incidence compared to IG users of comparable KFRE score. Kidney failure risk prediction equations need to updated with terms for SGLT2i or GLP-1RA use.
| KFRE Subgroup | Incidence in SGLT2i new-users (N=48,988) | Incidence in GLP-1RA new-users (N=12,379) | Incidence in Insulin Glargine new-users (N=28,472) |
| 3-year Incidence of Kidney Failure with Competing Risk of Death | |||
| <2% | 0.55% | 0.59% | 0.72% |
| 2 - <6% | 4.58% | 1.73% | 3.51% |
| ≥6% | 7.93% | 12.06% | 15.14% |
| 3-year incidence of All-Cause Death before Kidney Failure | |||
| <2% | 6.85% | 6.27% | 10.13% |
| 2 - <6% | 13.88% | 16.24% | 17.36% |
| ≥6% | 14.38% | 21.58% | 20.71% |
Funding
- NIDDK Support