Abstract: TH-OR046
GLP-1 Receptor Agonist Use Is Associated with Lower All-Cause Mortality in Veterans with Newly Diagnosed CKD
Session Information
- CKD Outcomes: Novel Biomarkers, Interventions, and Multiorgan Crosstalk
October 22, 2026 | Location: Mile High Ballroom 1D, Convention Center
Abstract Time: 04:30 PM - 04:40 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Swee, Melissa L., University of Iowa Health Care, Iowa City, Iowa, United States
- Gao, Yubo, Iowa City VA Medical Center, Iowa City, Iowa, United States
- Yamada, Masaaki, University of Iowa Health Care, Iowa City, Iowa, United States
- Griffin, Benjamin R., University of Iowa Health Care, Iowa City, Iowa, United States
- Robinson, Kathleen, University of Iowa Health Care, Iowa City, Iowa, United States
- Sarrazin, Mary Vaughan, University of Iowa Health Care, Iowa City, Iowa, United States
- Jalal, Diana I., Iowa City VA Medical Center, Iowa City, Iowa, United States
Background
The FLOW trial (2024) demonstrated that semaglutide reduces cardiovascular and kidney events in patients with diabetic CKD, leading to FDA approval for this indication in January 2025. Whether glucagon-like peptide-1 receptor agonist (GLP-1RA) use is associated with improved survival in the broader real-world CKD population remains unclear. We evaluated the association between GLP-1RA use and all-cause mortality, and factors associated with GLP-1RA initiation, in a national Veteran cohort with newly diagnosed CKD.
Methods
Using Veterans Health Administration data Jan 2016 through Nov 2025, we identified Veterans with newly diagnosed stage 3-4 CKD (defined by ≥2 eGFR measurements 15-59 mL/min/1.73 m2 obtained ≥60 days apart). The primary analysis used a Cox proportional hazards model with GLP-1RA use as a time-varying covariate to evaluate the association with all-cause mortality (n=1,419,039; 346,683 deaths), adjusted for age, sex, race/ethnicity, rurality, BMI, comorbidities (diabetes, heart failure, prior MI, prior kidney disease), proteinuria, baseline eGFR, blood pressure, and calendar year of CKD diagnosis. A secondary Cox model evaluated factors associated with time to first GLP-1RA initiation among 1,332,627 Veterans without prior GLP-1RA prescription.
Results
GLP-1RA use was associated with 21% lower all-cause mortality (HR 0.79, 95% CI 0.77-0.81), with semaglutide accounting for the majority of post-CKD initiations. In the initiation analysis, 131,975 Veterans (9.9%) initiated GLP-1RA therapy; uptake accelerated sharply by calendar year (2023 vs 2020: HR 2.19, 2.13-2.26). The dominant predictors of initiation were diabetes (HR 10.67, 10.50-10.85) and obesity (BMI ≥30: HR 4.56, 4.38-4.74; BMI 25-29.9: HR 2.09, 2.01-2.18). Initiation was lower in older Veterans, men (HR 0.75, 0.74-0.77), and Black non-Hispanic (HR 0.77, 0.76-0.78), Hispanic (HR 0.90, 0.88-0.93), and other non-White (HR 0.84, 0.81-0.87) Veterans.
Conclusion
In a national cohort of Veterans with newly diagnosed CKD, GLP-1RA use was associated with lower all-cause mortality, extending the kidney and cardiovascular benefits established in randomized trials to a real-world population. Despite accelerating uptake, real-world initiation remains concentrated among Veterans with diabetes and obesity, suggesting opportunities to broaden GLP-1RA use across the CKD population as kidney-specific indications expand.
Funding
- Veterans Affairs Support