Kidney Week

Abstract: SA-PO0411

Cardiorenal Outcomes and GLP-1 Receptor Agonist Therapy in Diabetic Kidney Disease: A Race- and Ethnicity-Stratified Real-World Cohort Study

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

• Almaraz Aguilar, Oscar David, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Oscar David Almaraz Aguilar, MD, MPH

• Sallam, Hanaa, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Hanaa Sallam, MD, PhD

• Lee, Wei-Chen, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Wei-Chen Lee, PhD

• Serag, Hani, The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Hani Serag, MD, MPH

• Israni, Ajay K., The University of Texas Medical Branch at Galveston, Galveston, Texas, United States

Ajay K. Israni, MD, MS

Background

Diabetic Kidney Disease (DKD) affects about 40% of adults with Type 2 Diabetes (T2D). The cardio-kidney-metabolic syndrome provides a framework for understanding cardiometabolic disease progression, but race- and ethnicity-specific cardiorenal trajectories following DKD diagnosis, and the role of glucagon-like peptide 1 receptor agonists (GLP-1RAs) in these outcomes, remain poorly characterized in real-world data.

Methods

Using TriNetX, we conducted two analyses. We identified adults with T2D (2006–2019) whose records included a first DKD code at least 1 year after T2D diagnosis, matched 1:1 to T2D patients without a recorded DKD code. We excluded patients with baseline eGFR below 60 mL/min/1.73 m2, type 1 diabetes, gestational diabetes, or malignancy. Propensity score matching on demographics, comorbidities, laboratories, and medications was performed independently within each racial and ethnic cohort (Index event: T2D diagnosis). Main outcomes were: 1) mortality, 2) end-stage renal disease (ESRD), and 3) major adverse cardiovascular events (MACE). In a second analysis, patients with GLP-1RA exposure within ±6 months of DKD diagnosis were matched 1:1 to DKD patients without GLP-1RA exposure (Index event: DKD diagnosis). Cox regression and competing risk analysis with CIF (Cumulative Incidence Function) were used. Outcomes were assessed from 1 year to 6 years post-index event. All analyses were performed using TriNetX.

Results

In the DKD vs. non-DKD analysis (n=34,160), DKD was independently associated with a significant increase in mortality (HR 1.36; 95% CI 1.27–1.45), ESRD (HR 15.61; 95% CI 12.97–18.80), and MACE (HR 2.32: 95% Cl 2.22-2.43). Competing risk analysis (CIF at 6 years) for MACE: Black (37.7%), White(34.8%), Latino (24.2%), and Asian (19.7%); for ESRD: Latino (8.1%), Black (6.6%), White (5.0%), and Asian (4.6%), and for mortality: 1.0–1.5%. In the GLP-1RA analysis (n=1064), GLP-1RA exposure showed a decreased but not statistically significant mortality risk (HR 0.79; 0.61–1.03), ESRD (HR 0.66; 0.43–1.01), and MACE (HR 0.81; 0.63–1.04).

Conclusion

In this cohort, DKD was associated with increased cardiorenal risk and disparate trajectories. These findings reinforce the need for early, equitable cardiorenal evaluation and intervention at DKD diagnosis and motivate further investigation of GLP-1RAs as potential modifiers of adverse cardiorenal trajectories.

Funding

• Other NIH Support