Comparative cardiovascular effectiveness of GLP-1RAs versus DPP-4is in dialysis patients with type 2 diabetes: a target trial emulation
Authors' conclusion
Compared with DPP-4is, sustained use of GLP-1RAs may reduce the risk of MACE among patients with T2D receiving maintenance dialysis. These findings suggest a potential cardiovascular benefit but require confirmation in randomized controlled trials before introduction into clinical practice.
Study context
- Population
- Adults aged ≥20 years with T2D receiving maintenance dialysis who initiated a GLP-1 RA or DPP-4i, April 2015–March 2023, Japanese administrative claims database
- Participants
- 4,793 adults
- Exposure
- GLP-1 RA vs DPP-4i initiation
- GLP-1RAn = 557
- DPP-4in = 4,236reference
- Outcome
- Major adverse cardiovascular events (MACE): composite of acute MI, stroke and cardiovascular death
- Follow-up
- 3 years
Methodological detailsadministrative claims database, inverse probability weighting, per-protocol effect
- Administrative claims database
- Inverse probability weighting
- Per-protocol effect
Main finding
As reported in the abstract
MACE
Each group vs DPP-4iRisk difference (95% CI)
GLP-1RA
−8.0%(−15.5% to 0.9%)
Each group vs DPP-4iRisk ratio (95% CI)
GLP-1RA
0.79(0.59–1.03)
Observational data: associations, not effects.
Original publication
Comparative cardiovascular effectiveness of GLP-1RAs versus DPP-4is in dialysis patients with type 2 diabetes: a target trial emulation. Diabetes Metab. Published 12 April 2026. doi:10.
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