Kidney Week

Abstract: TH-PO1276

GLP-1 Receptor Agonist Initiation and Mortality in Patients on Maintenance Hemodialysis: A Target Trial Emulation

Session Information

• Late-Breaking Research Posters
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Lama, Suman Kumar, Renal Research Institute, New York, New York, United States

Suman Kumar Lama, MS, MSc

• Chaudhuri, Sheetal, Renal Research Institute, New York, New York, United States

Sheetal Chaudhuri, PhD

• Blankenship, Derek M., Renal Research Institute, New York, New York, United States

Derek M. Blankenship, PhD, MBA

• Nandorine Ban, Andrea, Renal Research Institute, New York, New York, United States

Andrea Nandorine Ban, MS, MSc

• Usvyat, Len A., Renal Research Institute, New York, New York, United States

Len A. Usvyat, PhD, FASN

• Pecoits-Filho, Roberto, Pontificia Universidade Catolica do Parana, Curitiba, PR, Brazil

Roberto Pecoits-Filho, MD, PhD, FASN

• Hippen, Benjamin E., Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States

Benjamin E. Hippen, MD, FASN

Background

Patients with kidney failure receiving maintenance hemodialysis face high cardiometabolic mortality but are largely excluded from landmark randomized trials of glucagon-like peptide-1 receptor agonists (GLP-1RAs). We emulated a target trial to assess the impact of GLP-1RA initiation on mortality, hospitalizations, and metabolic parameters.

Methods

We conducted a nationwide retrospective target trial emulation among adults on in-center hemodialysis from January 1, 2020, through December 31, 2025. GLP-1RA initiators (>90 days on dialysis, meeting washout criteria) were 1:1 propensity score-matched to non-users. The primary outcome was all-cause mortality, assessed via matched-pair stratified Cox proportional-hazards models. Secondary outcomes included hospitalization metrics (time to first, recurrent rates, cumulative days) and changes in BMI, HbA1C, and serum albumin.

Results

The matched cohort included 8,589 pairs of GLP-1RA initiators and non-users. The matched population had a mean age of approximately 60 years, was 52% male, and had a high prevalence of baseline comorbidities, including diabetes (92%), congestive heart failure (31%), and coronary artery disease (27%). GLP-1RA initiation was associated with a lower hazard of all-cause mortality (pooled HR, 0.73; 95% CI, 0.665–0.802; p<0.001). This mortality association persisted in a sensitivity analysis of patients with at least 2 years of potential follow-up. GLP-1RA use significantly decreased BMI and HbA1C, while serum albumin changes mirrored the control group. Initiation was also associated with a lower hazard of first hospitalization (HR, 0.944; 95% CI, 0.900–0.989; p=0.018), lower recurrent-hospitalization rates (IRR, 0.936; 95% CI, 0.887–0.988; p=0.017), and fewer cumulative inpatient days (mean within-pair difference, −1.38 days; 95% CI, −2.59 to −0.16; p=0.027).

Conclusion

Among adults on maintenance hemodialysis, GLP-1RA initiation was associated with decreased BMI and HbA1C, alongside lower all-cause mortality and overall hospitalization burden versus matched non-users. Given the low likelihood of an adequately powered randomized trial in this population, this convergent evidence offers a meaningful basis to inform clinical practice regarding GLP-1RA use in patients receiving maintenance dialysis.

Funding

• Commercial Support – Fresenius Medical Care