End-stage renal diseases associated with SGLT2 inhibitors versus GLP-1 receptor agonists in metabolic dysfunction-associated steatotic liver disease

Abstract

Aims: to compare the renal effectiveness of SGLT2 inhibitors (SGLT2i) versus GLP-1 receptor agonists (GLP-1RA) in metabolic dysfunction-associated steatotic liver disease (MASLD).

Methods: using nationwide healthcare claims (2014–2023) of Korea, we constructed a cohort of MASLD patients who initiated SGLT2i or GLP-1RA. Patients were stratified on baseline status of chronic kidney disease (CKD). New-users of SGLT2i and GLP-1RA were 1:1 propensity score (PS) matched. Incidence rates (IRs) per 1,000 person-years, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated for a composite of end-stage renal diseases (ESRD).

Results: of 333,082 MASLD patients who initiated SGLT2i or GLP-1RA, a total of 1,268 SGLT2i-GLP-1RA pairs were PS-matched in cohort with CKD, while 10,996 pairs were matched in cohort without CKD. For the cohort with CKD, SGLT2i presented 33% lower risk of ESRD compared to GLP-1RA (20.3 vs. 30.0 events per 1,000 person-years; HR 0.67, 95% CI 0.45–1.00). For the cohort without CKD, SGLT2i presented a 68% lowered risk of ESRD compared to GLP-1RA (0.9 vs. 2.5 events per 1,000 person-years; HR 0.32, 95% CI 0.19–0.53).

Conclusions: the use of SGLT2i was associated with lower risk of ESRD compared to GLP-1RA in MASLD. The protective association was presented regardless of CKD status.

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Identifiers

ORCID for Christopher D. Byrne: orcid.org/0000-0001-6322-7753

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