Abstract: FR-OR087
Tirzepatide vs. Dulaglutide Is Associated with Reduced Major Kidney Events in Patients with Type 2 Diabetes, CVD, and Very High-Risk Kidney Diseases
Session Information
- High-Impact Clinical Trials - 1
November 07, 2025 | Location: Hall A, Convention Center
Abstract Time: 11:50 AM - 12:05 PM
Category: Diabetic Kidney Disease
- 702 Diabetic Kidney Disease: Clinical
Authors
- Zoungas, Sophia, Monash University, Melbourne, Victoria, Australia
- Nicholls, Stephen, Monash University, Melbourne, Victoria, Australia
- Miller, Debra L, Eli Lilly and Company, Indianapolis, Indiana, United States
- Nishiyama, Hiroshi, Eli Lilly and Company, Indianapolis, Indiana, United States
- Wiese, Russell J, Eli Lilly and Company, Indianapolis, Indiana, United States
- D'Alessio, David A., Duke University Medical Center, Durham, North Carolina, United States
Background
In SURPASS-CVOT, among patients with type 2 diabetes (T2D) and atherosclerotic cardiovascular disease (ASCVD), tirzepatide (TZP) reduced eGFR decline, albuminuria progression and the risk of the composite major kidney outcome compared with dulaglutide (DULA). These post-hoc analyses explore the potential benefits and safety of TZP versus DULA in the most vulnerable patients studied with very high-risk CKD.
Methods
Very high-risk CKD was defined using the KDIGO 2025 guideline as eGFR < 30 mL/min/1.73 m2 or eGFR ≥ 30 to <45 mL/min/1.73 m2 and micro/macroalbuminuria or eGFR ≥45 to <60 mL/min/1.73 m2 and macroalbuminuria. Changes from baseline to 36 months in eGFR and urinary albumin/creatinine ratio (UACR) were assessed using analysis of covariance models, with treatment, SGLT2 inhibitor use at baseline, country, and baseline values as fixed covariables, with multiple imputation of missing data. The composite kidney outcome of onset of macroalbuminuria, ≥50% reduction in eGFR, onset of end stage kidney disease, or kidney-related death, was analyzed using Cox proportional hazards models stratified by SGLT2 inhibitor use at baseline.
Results
A total of 1241 patients had very high-risk CKD (mean age 68.5 years; mean BMI 33.0; mean HbA1c 8.5%; mean duration of diabetes 19.2 years; SGLT2 inhibitor use 24.9%). Changes in eGFR at 36 months were −3.0 (0.5) for TZP and −7.2 (0.4) for DULA with a significant difference of 4.1 mL/min per 1.73 m2 (table). The percent changes in UACR at 36 months were −45.6 for TZP and −28.0 for DULA with a significant difference of -24.6 g/kg (table). The risk of the four-component composite kidney outcome was 33% lower with TZP treatment than DULA treatment (108 [16.7%] versus 137 [23.0%], HR 0.67, 95% CI 0.52 to 0.87 p=0.002).
Conclusion
As observed in the overall population, tirzepatide compared with dulaglutide was associated with reduced decline in kidney function, progression of albuminuria and risk of the composite kidney outcome in patients with T2D, ASCVD and very high-risk CKD.
Funding
- Commercial Support – Eli Lilly and Company