A matched retrospective cohort study published in the Clinical Journal of the American Society of Nephrology reports that use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) was independently associated with lower hospitalization and mortality rates among patients starting in-center hemodialysis.

GLP-1RAs are the drug class that includes semaglutide, widely prescribed for type 2 diabetes and obesity. The authors note that the FLOW trial previously showed semaglutide reduced the risk of clinical outcomes and death from cardiovascular causes in patients with chronic kidney disease and type 2 diabetes, and the open question was whether patients with end-stage kidney disease (ESKD) see similar benefit.

How the cohort was built

Researchers included adult ESKD patients who began thrice-weekly in-center hemodialysis at a kidney care organization between January 2018 and April 2024. Drawing on internal electronic health record data, they matched 2,492 patients with evidence of a GLP-1RA prescription in the first 30 days after dialysis initiation one-to-one with eligible patients who had no such prescription.

Follow-up ran from the index date until death or the end of the study period on July 31, 2024. Incidence rate ratios were estimated using a negative binomial distribution with a random intercept to account for the matched design.

Who actually got the prescription

The treated group had a mean age of 63 years and was predominantly male at 59 percent. Compared with other eligible dialysis patients, nearly all had a known diabetes diagnosis (98 percent versus 73 percent), more had evidence of predialysis nephrology care (76 percent versus 67 percent), and mean BMI was higher at 33 kg/m2 versus 30 kg/m2. That is a healthier-engaged, more clearly diabetic population, which is exactly why the matching matters.

Key results

After matching and adjustment, GLP-1RA use was independently associated with a lower hospitalization rate, with an incidence rate ratio of 0.91 (95 percent CI 0.87 to 0.96). The mortality rate ratio was 0.83 (0.73 to 0.95).

The authors summarize this as a 9 percent lower hospitalization rate and a 17 percent lower mortality rate among incident in-center hemodialysis patients on a GLP-1RA.

Limitations

This was a retrospective cohort study drawn from the electronic health records of a single kidney care organization, not a randomized trial, and the authors describe the findings as associations rather than proof of benefit. The treated and untreated groups differed at baseline on diabetes diagnosis, race, predialysis care and BMI, differences the matching and adjustment were intended to address.

Where the evidence stops

What the study establishes is that GLP-1RA use in the first month of dialysis was associated with fewer hospitalizations and deaths in this population. Whether the drugs themselves produce that difference in patients with end-stage kidney disease remains unsettled by this design.