#1608 Glucagon-like peptide-1 receptor agonists and the risk of emergency department visits and hospitalization in patients across the spectrum of kidney disease

Abstract Background and Aims Glucagon-like-peptide-1 receptor agonists (GLP1RA) have emerged as a therapy that promotes weight loss and confers cardiorenal protection. While recent trials have suggested benefit on heart failure hospitalizations; their effects on all-cause emergency department (ED) visits and hospitalizations have not been well characterized. In this population-based study we examined the effect of initiating a GLP1RA versus a dipeptidyl peptidase 4 inhibitor (DPP4i) on ED visits and all-cause hospitalization in patients across the spectrum of chronic kidney disease (CKD). Method This retrospective cohort study was conducted in Ontario, Canada, using administrative databases housed at ICES. We included a cohort of patients aged ≥18 years with eGFR <90 ml/min/1.73 m2 who received a first prescription of a GLP1RA or DPP4i through the Ontario Drug Benefit between September 30, 2019 to December 31, 2021. Follow-up extended until June 30, 2022. We used inverse probability of treatment weighting (IPTW) based on a propensity score conditioned on 72 covariates to address confounding. We evaluated the effect of GLP1RA initiation on all cause ED visits and hospitalization using time-to-recurrent-event approaches with the Prentice-Williams-Peterson (PWP) gap time model which assumes an event-specific hazard for each ED encounter or hospitalization. In an additional analysis, we evaluated recurrent ED visits and/or hospitalizations using the Andersen-Gill extension of the Cox proportional hazards model and robust sandwich estimators to obtain the 95% confidence intervals. Results The study cohort included 24,576 patients who were new users of a GLP1RA, and 23,600 who were new users of a DPP-4i eGFR <90 ml/min/1.73 m2. Baseline characteristics were balanced between groups (mean age of 69 years, 50% female, 92% with type 2 diabetes mellitus, 3.5% had heart failure, and 41% had CKD stages 3–5). Semaglutide represented 98.4% of GLP1RA prescriptions. Across the cohort, 9.6% had more than one hospitalization while 25.8% had more than one emergency department encounter. Using the PWP gap time model, new use of GLP1RA was associated with a lower risk of all-cause ED encounters or hospitalizations: HR 0.90 (95% CI, 0.87 to 0.94; P < 0.0001). This finding was consistent when we used the calendar time model (HR 0.90; 95% CI, 0.87 to 0.94) or the Andersen-Gill extension of the Cox proportional hazards model (HR 0.87; 95% CI, 0.82 to 0.92) (Table 1). Conclusion In this large population-based study, GLP1RA initiation was associated with a reduction in all-cause ED visits and/or hospitalizations when compared to DPP-4 inhibitor initiation. This finding has potentially substantial implications on health care delivery and resource utilization.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.