Glucagon-Like Peptide-1 Receptor Agonists and Cardiovascular Outcomes in Dialysis Patients With Type 2 Diabetes: A Real-World Propensity Score–Matched Study

Abstract Aims Patients with type 2 diabetes mellitus (T2DM) undergoing dialysis have extremely high cardiovascular and mortality risks, yet evidence for effective therapies is limited. The benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in this population remain unclear. Methods We conducted a retrospective, propensity score–matched cohort study using the TriNetX US Collaborative Network (2013–2022). Among 1 688 matched pairs of new GLP-1 RA and DPP-4i users, the primary outcome was major adverse cardiovascular events (MACE), with secondary outcomes of all-cause mortality, heart failure, sepsis, hospitalization, and emergency visits. Results GLP-1 RAs users experienced significantly lower risk of MACE compared with DPP-4i users (HR 0.88, 95% CI 0.78–0.99). GLP-1 RAs were also associated with reduced all-cause mortality (HR 0.84, 95% CI 0.72–0.99), myocardial infarction (HR 0.84, 95% CI 0.70–0.99), heart failure (HR 0.87, 95% CI 0.78–0.98), and sepsis (HR 0.81, 95% CI 0.71–0.92). Healthcare utilization outcomes as hospitalization and emergency visits were also reduced. Findings were consistent across sensitivity and subgroup analyses. Conclusions In this large real-world dialysis cohort, GLP-1 RAs were associated with improved cardiovascular outcomes, survival, infection risk, and healthcare utilization, supporting their potential role in T2DM patients receiving dialysis.