Edmonston, DanielMulder, HillaryLydon, ElizabethChiswell, KarenLampron, ZacharyShay, ChristinaMarsolo, KeithShah, Raj CJones, W SchuylerGordon, HowardHwang, WenkeAyoub, IsabellaFord, DanielChamberlain, AlannaRao, AjaykumarFonseca, VivianChang, AlexanderAhmad, FarazHung, AdrianaHunt, KellyButler, JavedBosworth, Hayden BPagidipati, Neha2024-09-072024-09-072024-080735-10971558-3597https://hdl.handle.net/10161/31462<h4>Background</h4>Emerging data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) improve kidney outcomes for people with type 2 diabetes (T2D). Direct comparisons of the kidney and cardiovascular effectiveness of GLP-1 RA with sodium-glucose cotransporter 2 inhibitors (SGLT2i), a first-line therapy for this population, are needed.<h4>Objectives</h4>The authors compared kidney and cardiovascular outcomes for new users of SGLT2i and GLP-1 RAs with T2D.<h4>Methods</h4>Using propensity score overlap weighting, we analyzed electronic health record data from 20 U.S. health systems contributing to PCORnet between 2015 and 2020. The primary kidney outcome was a composite of sustained 40% estimated glomerular filtration rate (eGFR) decline, incident end-stage kidney disease, or all-cause mortality over 2 years or until censoring. In addition, we examined cardiovascular and safety outcomes.<h4>Results</h4>The weighted study cohort included 35,004 SGLT2i and 47,268 GLP-1 RA initiators. Over a median of 1.2 years, the primary outcome did not differ between treatments (HR: 0.91; 95% CI: 0.81-1.02), although SGLT2i were associated with a lower risk of 40% eGFR decline (HR: 0.77; 95% CI: 0.65-0.91). Risks of mortality (HR: 1.08; 95% CI: 0.92-1.27), a composite of stroke, myocardial infarction, or death (HR: 1.03; 95% CI: 0.93-1.14), and heart failure hospitalization (HR: 0.95; 95% CI: 0.80-1.13) did not differ. Genital mycotic infections were more common for SGLT2i initiators, but other safety outcomes did not differ. The results were similar regardless of chronic kidney disease status.<h4>Conclusions</h4>SGLT2i and GLP-1 RAs led to similar kidney and cardiovascular outcomes in people with T2D, though SGLT2i initiation was associated with a lower risk of 40% eGFR decline. (Evaluating Comparative Effectiveness of Empagliflozin in Type 2 Diabetes Population With and Without Chronic Kidney Disease; NCT05465317).https://creativecommons.org/licenses/by-nc/4.0HumansKidney Failure, ChronicCardiovascular DiseasesDiabetes Mellitus, Type 2Hypoglycemic AgentsGlomerular Filtration RateAgedMiddle AgedFemaleMaleGlucagon-Like Peptide-1 ReceptorSodium-Glucose Transporter 2 InhibitorsGlucagon-Like Peptide-1 Receptor AgonistsJournal article