Drug Effectiveness

1A-05 - End-stage renal diseases associated with the use of SGLT2 inhibitors versus GLP-1 receptor agonists among individuals with metabolic dysfunction-associated steatotic liver disease: A nationwide cohort study

Sunday, August 24, 2025

11:30 AM - 11:45 AM ET

Location: 207AB

Presenting Author(s)

HK

Hwa Yeon Ko, PharmD

School of Pharmacy, Sungkyunkwan University, Suwon, South Korea, Republic of Korea

Co-Author(s)

BH

Bin Hong

School of Pharmacy, Sungkyunkwan University, Suwon, South Korea, Republic of Korea
SB

Sungho Bea, PharmD, PhD

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, United States
JB

Jae Hyun Bae

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, Republic of Korea
YC

Young Min Cho

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea, Republic of Korea
YC

Yoosoo Chang, MD, PhD

Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, Republic of Korea
SR

Seungho Ryu

Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, Republic of Korea
CB

Christopher Byrne

National Institute for Health and Care Research, Southampton Biomedical Research Centre, University Hospital Southampton, Southampton, United Kingdom, United Kingdom
JS

Ju-Young Shin, PharmD, PhD

School of Pharmacy, Sungkyunkwan University, Suwon, South Korea, Republic of Korea

Background: Randomized controlled trials have demonstrated the renal benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon like peptide-1 receptor agonists (GLP-1RA) among patients with type 2 diabetes (T2D). However, no head-to-head trial has been conducted on the renal effectiveness of these agents in individuals with metabolic dysfunction-associated steatotic liver disease (MASLD).

Objectives: To assess comparative renal effectiveness of SGLT2i versus GLP-1RA among individuals with MASLD

Methods: Using nationwide healthcare claims (2014-2023) of Korea, we constructed a cohort of MASLD patients who initiated SGLT2i or GLP-1RA. Patients were stratified on baseline status of chronic kidney disease (CKD). New-users of SGLT2i were 1:1 propensity score (PS) matched to new-users of GLP-1RA. We assessed a composite of end-stage renal diseases (ESRD), comprising CKD stage 5, kidney failure, dialysis, renal transplant, and renal death. Incidence rates (IRs) per 1,000 person-years, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated.

Results: Of 333,082 MASLD patients who initiated SGLT2i or GLP-1RA, 17,677 (5.3%) had CKD, and 315,405 (94.7%) did not have CKD at baseline. A total of 1,268 SGLT2i-GLP-1RA pairs were PS-matched in the cohort with CKD, while 10,996 pairs were matched in the cohort without CKD. For the cohort with CKD, SGLT2i presented a 33% lowered risk of ESRD compared to GLP-1RA (20.3 vs. 30.0 events per 1,000 person-years; HR 0.67, 95% CI 0.45-1.00, p-value 0.048). For the cohort without CKD, SGLT2i presented a 68% lowered risk of ESRD compared to GLP-1RA (0.9 vs. 2.5 events per 1,000 person-years; HR 0.32, 95% CI 0.19-0.53, p-value < 0.001).

Conclusions: In this nationwide cohort study, the use of SGLT2i was associated with a lower risk of ESRD compared to GLP-1RA in individuals with MASLD. The protective association was presented regardless of baseline CKD status, suggesting that SGLT2i may be a preferred option over GLP-1RA at any stage of the disease course.