American Diabetes Association
GLP1_renal_supplementary_material_16Jan2020.docx (523.57 kB)

Use of glucagon-like peptide-1-receptor-agonists and risk of serious renal events: Scandinavian cohort study

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posted on 2020-04-15, 16:57 authored by Björn Pasternak, Viktor Wintzell, Björn Eliasson, Ann-Marie Svensson, Stefan Franzén, Soffia Gudbjörnsdottir, Kristian Hveem, Christian Jonasson, Mads Melbye, Henrik Svanström, Peter Ueda

To assess the association between use of GLP1-receptor-agonists and risk of serious renal events in routine clinical practice.

Research Design and Methods

Cohort study using an active-comparator new-user design and nationwide register data from Sweden, Denmark and Norway, 2010-2016. The cohort included 38,731 new users of GLP1-receptor-agonists (liraglutide 92.5%; exenatide 6.2%; lixisenatide 0.7%; dulaglutide 0.6%), matched 1:1 on age, sex and propensity score to a new user of the active comparator, dipeptidyl-peptidase-4 (DPP-4) inhibitors. The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes and hospitalization for renal events. Secondary outcomes were the individual components of the main outcome. Hazard ratios (HRs) were estimated using Cox models and an intention-to-treat exposure definition. Mean (SD) follow-up time was 3.0 (1.7) years.


Mean (SD) age of the study population was 59 (10) years and 18% had cardiovascular disease. A serious renal event occurred in 570 users of GLP1-receptor-agonists (incidence rate 4.8 events per 1000 person-years) and in 722 users of DPP4 inhibitors (6.3 events per 1000 person-years; hazard ratio [HR] 0.76, 95% CI 0.68-0.85; absolute difference -1.5 [-2.1 to -0.9] events per 1000 person-years). Use of GLP1-receptor-agonists was associated with a significantly lower risk of renal replacement therapy (HR 0.73 [0.62-0.87]) and hospitalization for renal events (HR 0.73 [0.65-0.83]) but not death from renal causes (HR 0.72 [0.48-1.10]). When using an as-treated exposure definition in which patients were censored at treatment cessation or switch to the other study drug, the HR for the primary outcome was 0.60 (0.49-0.74).


In this large cohort of patients seen in routine clinical practice in three countries, use of GLP1-receptor-agonists, as compared with DPP4 inhibitors, was associated with a reduced risk of serious renal events.


Dr Ueda was supported by grants from the Swedish Heart-Lung Foundation and the Swedish Society for Medical Research. Dr Pasternak was supported by an investigator grant from the Strategic Research Area Epidemiology program at Karolinska Institutet. The study was conducted with research grant support from the Swedish Cancer Society and the Novo Nordisk Foundation.


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