Kidney Outcomes With GLP-1 Receptor Agonists and Tirzepatide Versus Finerenone in Type 2 Diabetes and Chronic Kidney Disease: A Real-World Cohort Study
- Design
- Retrospective cohort · 4554 participants · Mixed outcome
- Match to healthy normal-weight adults aged 55–75
- Different populationINDIRECT: all participants had type 2 diabetes and CKD stages 3-4 (mean age 70.7 years); BMI is not reported.
- Could weight loss explain it?
- PossiblyNo weight or HbA1c change and no mediation analysis are reported; stratifying by baseline HbA1c and BMI tests effect modification and does not separate weight or glycaemic effects.
- Study tier
- Study tier 3LOW: single retrospective propensity-matched cohort with an active comparator; a single observational study is capped at LOW.
- Assessment
- Version 3 · Two independent AI reviews agreed · Oct 19, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75.
In a TriNetX health-record study of 4554 matched adults with type 2 diabetes and moderate chronic kidney disease (mean age 70.7 years), starting a GLP-1 drug or tirzepatide rather than finerenone was linked to a lower relative risk of kidney failure, stage 5 disease or dialysis (110 vs 136 events; hazard ratio 0.71). The absolute risk difference was not significant, and the chronic eGFR slope did not differ, though the total slope favoured the GLP-1 group. This is observational, and missing albuminuria data leave room for confounding.
01Findings
What the study reported
- Drugs
- Glp-1 receptor agonists, Tirzepatide
- Comparator
- finerenone
- Dose
- various
- Primary outcome
- composite of ESKD, Stage 5 CKD, or dialysis initiation
- Effect
- Kidney composite HR 0.71 for GLP-1/GIP RAs versus finerenone (110 vs 136 events); 2.5-year absolute risk difference -1.14%, CI crossing zero; total eGFR slope difference 1.04 mL/min/1.73 m2/year; chronic slope difference -0.08, CI crossing zero
- 95% confidence interval
- 95% CI: 0.55-0.91 (hazard ratio)
- Follow-up
- ≤ 2.5 years
- Adverse events
- not reported in abstract
- Limitations
- Observational propensity-matched cohort with an active comparator from a different drug class; baseline albuminuria was missing for most participants, so residual confounding is possible, and the authors say findings apply to this matched population.
Who was studied
- Mean age
- 70.7 years
- Sex distribution
- 43.3% women
- Obesity status
- not reported in abstract
- Diabetes status
- type 2 diabetes required
- Cvd status
- not reported in abstract
- Ckd status
- CKD stages 3-4 required
- Baseline condition
- type 2 diabetes with CKD stages 3-4 (moderate chronic kidney disease)
- Sample size
- 4554
- Inclusion exclusion
- adults with T2D and CKD stages 3-4 initiating GLP-1/GIP RAs or finerenone, 1:1 propensity-score matched
Study quality details
- Study design
- Retrospective cohort
- Sample size
- 4554
- Randomization
- no
- Blinding
- n/a
- Comparator
- finerenone
- Follow up duration
- ≤ 2.5 years
- Outcome type
- mixed
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- INDIRECT
- Statistical precision
- CI reported: 95% CI: 0.55-0.91 (hazard ratio)
- Risk of bias
- not assessed
- Funding conflicts
- unclear
- Peer review status
- yes
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- not reported in abstract
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
[AIM] 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). [METHODS] 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. [RESULTS] 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. [CONCLUSIONS] 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.