737-P: Acute Healthcare Utilization, Mortality, and Cardiovascular Events following GLP-1-RA Initiation by Patients with Advanced Chronic Kidney Disease—A Real-World Comparative Study

Introduction & Objective: Treatment with glucagon-like peptide-1 receptor agonists (GLP1-RA) in patients with type 2 diabetes and chronic kidney disease (CKD) may attenuate the progression of renal disease and cardiovascular events but their real-world impact on healthcare utilization and mortality in this population are not well-defined. This study aims to compare outcomes following initiation of GLP1-RA vs Dipeptidyl peptidase-4 inhibitors (DPP4i), as active comparators, in patients with diabetes and advanced CKD.

Methods: Retrospective cohort study using data from Veterans Health Administration during fiscal years 2006 to 2021. Inclusion criteria included U.S. veterans aged 35 years or older with advanced CKD who filled either GLP1-RA or DPP4i prescriptions. The primary outcome was acute healthcare utilization. Secondary outcomes were all-cause mortality and acute cardiovascular events (not including death).

Results: The eligible cohort included 26,997 GLP1-RA users and 37,708 DPP4 users. After propensity score matching (16,076 pairs) and 2.2 years mean follow-up duration, use of GLP1-RA was associated with lower annual rate of acute healthcare utilization (coefficient of regression β = -0.15, 95% CI -0.25 to -0.05, p=0.004) and lower all-cause mortality as compared to the DPP4i group (OR 0.84, 95% CI 0.79 to 0.89, p<0.01) with time-to- death analysis showing a HR of 0.86 (95%CI: 0.82-0.90, p <0.001). There was no significant difference in cardiovascular events between groups (OR 0.98, 95% CI 0.92 to 1.06, p=0.66). Conclusions: Use of GLP1-RA in patients with advanced CKD was associated with lower annual rate of acute healthcare utilization and decreased all-cause mortality. There was no significant difference in cardiovascular events between the matched groups.