GLP-1 drugs outperform DPP-4 inhibitors in advanced kidney disease with 9.6% weight loss and superior glycemic control | Research

The takeaway

In 236 patients with advanced CKD/ESKD, GLP-1 agonists achieved -9.6% weight loss vs -2.4% with DPP-4i (p<0.001) and -1.0% vs +0.2% HbA1c change over 36 months, with good treatment persistence.

-9.6% weight loss in CKD/ESKD
GLP-1 drugs achieved substantial weight loss and glycemic improvement in advanced kidney disease patients, a population where they are often underused

What the researchers found

GLP-1RA vs DPP-4i at 36 months: weight -9.6% vs -2.4% (ETD -7.1 percentage points, p<0.001); HbA1c -1.0% vs +0.2% (ETD -1.2, p=0.04). Treatment duration: GLP-1RA 1036 days, DPP-4i 1109 days.

Why it matters

GLP-1 drugs are underused in advanced kidney disease despite guidelines recommending them. This real-world evidence demonstrates they are effective and well-tolerated in this high-risk population, potentially encouraging more appropriate prescribing.

How the study worked

Retrospective cohort of 236 patients (149 GLP-1RA, 87 DPP-4i) with T2D and advanced CKD or ESKD. Electronic health records with manual chart review. Outcomes at 36 months.

What this study cannot tell us

Retrospective, non-randomized. GLP-1RA and DPP-4i groups may differ in unmeasured ways. No cardiovascular or renal outcome data. Single-center. No specific CKD progression data.

How to read the evidence

Retrospective cohort with manual chart review. Good real-world evidence but limited by non-randomized design.

When this study was published

Published in 2025.

The bigger picture

Cardiovascular disease is the leading killer in diabetic CKD/ESKD. Demonstrating GLP-1 drug effectiveness in this population—where they are often avoided—could save lives by encouraging appropriate use of a class proven to reduce cardiovascular events.

Questions still open

Are GLP-1 drugs safe for dialysis patients long-term?
Does the weight loss benefit translate to cardiovascular event reduction in CKD/ESKD?
Why are GLP-1 drugs underused in advanced CKD despite guideline recommendations?

Common questions

Can you take GLP-1 drugs with kidney disease?

Yes. This study of 236 patients with advanced kidney disease (including those on dialysis) showed GLP-1 drugs were well-tolerated and effective over 3 years, producing significant weight loss and blood sugar improvement. Despite safety concerns that limit their use, these results support prescribing them in this population.

How much better are GLP-1 drugs than DPP-4 inhibitors in kidney disease?

Substantially better. GLP-1 drugs produced 9.6% weight loss versus 2.4% with DPP-4 inhibitors, and HbA1c dropped by 1.0% versus a 0.2% increase with DPP-4 inhibitors over 3 years. Both treatments were well-tolerated.

Read the original research

Glucagon-like Peptide-1 receptor agonists versus dipeptidyl-peptidase 4 inhibitors in advanced chronic kidney disease and end stage kidney disease: Real world effectiveness and persistence of therapy.

Journal of diabetes and its complications, 39(1), 108925

View on PubMed ↗Publisher’s paper ↗

Citation

Sidra, F N U; Agarwal, Shubham; Lockhart Pastor, Paola; Xie, Donglu; Li, Xilong; Lingvay, Ildiko. (2025). Glucagon-like Peptide-1 receptor agonists versus dipeptidyl-peptidase 4 inhibitors in advanced chronic kidney disease and end stage kidney disease: Real world effectiveness and persistence of therapy.. Journal of diabetes and its complications, 39(1), 108925. https://doi.org/10.1016/j.jdiacomp.2024.108925