Abstract: TH-PO0497
GLP-1 Receptor Agonists vs. Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors and Risk of Dementia in Patients with Diabetes Requiring Hemodialysis
Session Information
- Top Trainee Posters - 1
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 01:54 PM - 02:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Kilpatrick, Mark Duncan, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Le, Dustin, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Kraft, Walter K., Thomas Jefferson University, Philadelphia, Pennsylvania, United States
- Grams, Morgan, NYU Langone Health, New York, New York, United States
- Jaar, Bernard G., Johns Hopkins University Welch Center for Prevention Epidemiology and Clinical Research, Baltimore, Maryland, United States
- Shin, Jung-Im, Johns Hopkins University Welch Center for Prevention Epidemiology and Clinical Research, Baltimore, Maryland, United States
Background
Prior studies reported that glucagon-like peptide-1 agonists (GLP1s) (versus dipeptidyl peptidase-4 inhibitors [DPP4s]) were associated with a reduced risk of dementia in the general population with type 2 diabetes, but if this is true for patients requiring hemodialysis is unknown.
Methods
Using the United States Renal Data System and Medicare Parts A, B, and D claims data from 2011 to 2021, we conducted a target trial emulation study (new user, active comparator design) to evaluate the association between GLP1s (vs DPP4s) and the risk of incident dementia among individuals with diabetes requiring hemodialysis. We used inverse probability of treatment weights (IPTW) to balance baseline characteristics, and we used Fine-Gray models to estimate sub-distribution hazard ratios (sHRs) accounting for competing risks of death and kidney transplantation. We estimated intention-to-treat and as-treated effects. We evaluated gastrointestinal (GI) symptoms as a positive control outcome.
Results
We identified 3,640 GLP1 new users and 11,729 DPP4 new users. After IPTW, the average age was 63 years old, 64% were white, and the mean BMI was 31 kg/m2. The median (interquartile interval) follow-up was 1.5 (0.6 - 2.9) years. In the intention-to-treat analysis, the IPTW-sHR for dementia was 0.80 (95% CI: 0.66 - 0.96), and after 5 years of follow-up, the cumulative incidence of dementia was 15.1% on GLP1s vs 18.6% on DPP4s (See Figure 1). Results were consistent across subgroups by age, baseline insulin use, and history of cerebrovascular disease. As-treated analyses were overall consistent. GLP1s were associated with an increased risk of gastrointestinal (GI) symptoms (HR 1.17, 95% CI 1.07 - 1.28).
Conclusion
In patients with diabetes requiring hemodialysis, GLP1s (vs DPP4s) were associated with a lower risk of dementia. Our findings need to be confirmed, but GLP1s may provide an opportunity to reduce the risk of dementia development in patients with diabetes requiring hemodialysis.