Kidney Week

Abstract: SA-PO0406

Bridging the Treatment Gap: SGLT2 Inhibitors and GLP-1 Receptor Agonists and Outcomes in Patients with Diabetes and CKD

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Cohen-Hagai, Keren, Tel Aviv University, Tel Aviv-Yafo, Tel Aviv District, Israel

Keren Cohen-Hagai, MD

• Zitman-Gal, Tali, Tel Aviv University, Tel Aviv-Yafo, Tel Aviv District, Israel

Tali Zitman-Gal, PhD

• Kalantar-Zadeh, Kamyar, The Lundquist Institute, Torrance, California, United States

Kamyar Kalantar-Zadeh, MD, DrMed, PhD, MPH, FASN

• Einbinder, Yael, Tel Aviv University, Tel Aviv-Yafo, Tel Aviv District, Israel

Yael Einbinder, MD

• Topaz, Guy, Meir Medical Center, Kefar Sava, Center District, Israel

Guy Topaz, MD

• Chen, Jacob, Tel Aviv University, Tel Aviv-Yafo, Tel Aviv District, Israel

Jacob Chen, MD, MSc, MBA

• Pereg, David, Meir Medical Center, Kefar Sava, Center District, Israel

David Pereg

Background

Patients with type 2 diabetes (T2D) and chronic kidney disease (CKD) are at high risk for kidney failure and death. SGLT2 inhibitors and GLP-1RA improve outcomes, yet their real-world use in patients with diabetic CKD remains incompletely characterized and they are underutilize.

Methods

This nationwide, real-world cohort study included patients with T2D and a urinary albumin-to-creatinine ratio of more than 30 mg/gr. Patients were stratified according to baseline eGFR (<30 or ≥30 ml/min/1.73m2) and categorized according to treatment status (SGLT2i alone, GLP-1RA alone, combined therapy, or neither therapy). The primary composite outcome was death from any cause or end-stage kidney disease (ESKD)

Results

A total of 240,734 patients were included. 132,693 patients (55.1%) were not treated with either a GLP-1RA or a SGLT2i. 30,803 patients (12.8%) received both agents, 44,007 (18.3%) received a GLP-1RA alone, and 33,231 (13.8%) received an SGLT2i alone.
Among patients with an eGFR >30 mL/minute/1.73m2, the adjusted hazard ratios for all cause death were 0.33 (95% CI, 0.32- 0.34) with SGLT2i alone, 0.46 (95% CI, 0.44-0.48) with GLP-1RA alone, and 0.26 (95% CI, 0.25-0.28) with combined therapy.
Among those with an eGFR<30 mL/minute/1.73m2, the corresponding hazard ratios were 0.24 (95% CI, 0.19-0.29), 0.55 (95% CI, 0.48- 0.61), and 0.17 (95% CI, 0.13-0.23), respectively.
Factors associated with the absence of treatment with either a GLP-1RA or an SGLT2i included older age, female sex, lower eGFR, and the presence of cerebrovascular disease.

Conclusion

Treatment with SGLT2i and GLP-1RA was associated with improved survival and renal outcomes, with the greatest benefit observed with combination therapy. Despite robust evidence demonstrating efficacy of this therapy in this patient population, it remains underutilized, particularly among women, older adults, and patients with advanced kidney disease.

Event-free survival according to treatment group