背景:胰高血糖素样肽-1受体激动剂(GLP-1RAs)已证明在改善死亡率和心血管(CV)结局方面有效。然而,GLP-1RAs治疗对糖尿病患者透析开始时心肾结局的影响仍未被研究.
目的:本研究旨在探讨GLP-1RA在2型糖尿病患者透析开始时的长期益处。
方法:从TriNetX全球数据库中确定了一组正在开始透析的2型糖尿病患者。用GLP-1RA治疗的患者和用长效胰岛素(LAI)治疗的患者通过倾向评分进行匹配。我们专注于全因死亡率,四点主要不良心血管事件(4p-MACE),和主要不良肾脏事件(MAKE)。
结果:在82,041例开始透析的2型糖尿病患者中,2.1%(n=1685)的患者是GLP-1RA使用者(平均年龄59.3岁;55.4%为男性)。1682名患者被纳入倾向匹配组,用GLP-1RA或LAI治疗。在这项研究中,急性透析的主要原因是缺血性心脏病(17.2%),其次是心力衰竭(13.6%)和败血症(6.5%)。经过1.4年的中位随访,在透析开始时使用GLP-1RA与死亡率风险降低相关(风险比[HR]=0.63,p<0.001),4p-MACE(HR=0.65,p<0.001),和MAKE(HR=0.75,p<0.001)。这种关联在长效GLP-1RAs使用者中尤为显著,BMI较高,降低HbA1c,eGFR>15毫升/分钟/1.73毫升。透析开始时GLP-1RAs的新使用与MACE(p=0.047)和MAKE(p=0.004)的低风险显著相关。此外,在那些可以停止急性透析或长期使用GLP-1RA的人中,GLP-1RA的使用与较低的死亡风险相关。4p-MACE,和制作。
结论:鉴于本观察性研究的局限性,在透析开始时使用GLP-1RAs与MACE风险降低相关,MAKE,和全因死亡率。这些发现表明,在急性透析开始时,在糖尿病患者中使用GLP-1RA缺乏相关的危害。
BACKGROUND: Glucagon-like Peptide-1 Receptor Agonists (GLP-1RAs) have demonstrated efficacy in improving mortality and cardiovascular (CV) outcomes. However, the impact of GLP-1RAs therapy on cardiorenal outcomes of diabetic patients at the commencement of dialysis remains unexplored.
OBJECTIVE: This study aimed to investigate the long-term benefits of GLP-1RAs in type 2 diabetic patients at dialysis commencement.
METHODS: A cohort of type 2 diabetic patients initializing dialysis was identified from the TriNetX global database. Patients treated with GLP-1RAs and those treated with long-acting insulin (LAI) were matched by propensity score. We focused on all-cause mortality, four-point major adverse cardiovascular events (4p-MACE), and major adverse kidney events (MAKE).
RESULTS: Among 82,041 type 2 diabetic patients initializing dialysis, 2.1% (n = 1685) patients were GLP-1RAs users (mean ages 59.3 years; 55.4% male). 1682 patients were included in the propensity-matched group, treated either with GLP-1RAs or LAI. The main causes of acute dialysis in this study were ischemic heart disease (17.2%), followed by heart failure (13.6%) and sepsis (6.5%). Following a median follow-up of 1.4 years, GLP-1RAs uses at dialysis commencement was associated with a reduced risk of mortality (hazard ratio [HR] = 0.63, p < 0.001), 4p-MACE (HR = 0.65, p < 0.001), and MAKE (HR = 0.75, p < 0.001). This association was particularly notable in long-acting GLP-1RAs users, with higher BMI, lower HbA1c, and those with eGFR > 15 ml/min/1.73m2. GLP-1RAs\' new use at dialysis commencement was significantly associated with a lower risk of MACE (p = 0.047) and MAKE (p = 0.004). Additionally, GLP-1RAs use among those who could discontinue from acute dialysis or long-term RAs users was associated with a lower risk of mortality, 4p-MACE, and MAKE.
CONCLUSIONS: Given to the limitations of this observational study, use of GLP-1RAs at the onset of dialysis was associated with a decreased risk of MACE, MAKE, and all-cause mortality. These findings show the lack of harm associated with the use of GLP-1RAs in diabetic patients at the initiation of acute dialysis.