Kidney Outcomes With GLP-1 Receptor Agonists and Tirzepatide Versus Finerenone in Type 2 Diabetes and Chronic Kidney Disease: A Real-World Cohort Study.

Authors

Dvora R Sehtman-Shachar, Alisa Fishkin, Gil Leibowitz, Ofri Mosenzon, Meir Schechter, Genya Aharon-Hananel

Published in

Diabetes, obesity & metabolism. Oct 07, 2026. Epub Oct 07, 2026.

Abstract

To compare kidney outcomes after GLP-1 receptor agonists (RA) or tirzepatide (GLP-1/GIP RAs) versus finerenone initiation in adults with Type 2 diabetes (T2D) and moderate chronic kidney disease (CKD).
In a retrospective TriNetX global network study (July 2021-November 2025), adults with T2D and CKD stages 3-4 initiating GLP-1/GIP RAs or finerenone were 1:1 propensity-score matched and followed ≤ 2.5 years. The primary endpoint was a composite of ESKD, Stage 5 CKD, or dialysis initiation. Secondary analyses compared annual total (0-2.5 years) and chronic (0.5-2.5 years) estimated glomerular filtration rate (eGFR) slopes. Sensitivity analyses included positive/negative controls, extended follow-up, and stratification by age, sex, baseline kidney function, glycated haemoglobin A1c, BMI, specific GLP-1/GIP RA, and baseline medications.
Among 4554 individuals (43.3% women, mean age 70.7 years, mean eGFR 39.4 mL/min/1.73 m²), the primary endpoint occurred in 110 (4.8%) GLP-1/GIP RAs and 136 (6.0%) finerenone initiators (hazard ratio: 0.71 [95% CI: 0.55-0.91]; 2.5-year absolute risk difference: -1.14% [-2.45 to 0.17]). Between-group differences in total and chronic eGFR slope with GLP-1/GIP RA versus finerenone were 1.04 mL/min/1.73 m²/year [95% CI: 0.32 to 1.75] and -0.08 mL/min/1.73 m²/year [95% CI, -1.27 to 1.12], respectively. Sensitivity analyses were consistent. Baseline albuminuria data were missing for most participants.
In a real-world cohort, GLP-1/GIP RAs versus finerenone initiation was associated with a lower relative hazard of adverse kidney outcomes, without evidence of a difference in absolute risk. This was accompanied by total, but not chronic, eGFR slope mitigation. Residual confounding from under-sampled albuminuria is possible, and findings should be interpreted within this specific matched population.

PMID:
42842950
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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