# SGLT2-remmers en GLP-1-agonisten even veilig voor het netvlies bij CKD en diabetes

*geplaatst 2026-11-03 · Nierziekte · Kidney medicine · doi 10.1016/j.xkme.2026.101518 · https://hartvaat.nl/2026/11/01/sglt2-remmers-en-glp-1-agonisten-even-veilig-voor-het-netvlies-bij-ckd-en-diabet/*

Een grootschalige cohortstudie onder ruim 28.000 patiënten met een chronische nierziekte (stadie 3-4) en type-2 diabetes vergeleek het risico op incidentele niet-proliferatieve retinopathie en progressie van retinopathie bij initiëring van een SGLT2-remmer versus een GLP-1-agonist. Na matching was er geen significant verschil tussen beide groepen (incidentele NPDR: HR 0,98 [95% BI 0,87-1,10]; progressie: HR 0,92 [95% BI 0,76-1,12]). Deze bevindingen bieden klinische geruststelling voor huisartsen en internisten die deze middelen inzetten bij nierinsufficiëntie, zonder dat er een voorkeur voor retinoveiligheid hoeft te worden gehanteerd.

## English: Diabetic Retinopathy Risk in SGLT2i vs GLP1RA Initiators With CKD Stages 3-4 and Type 2 Diabetes.

A large population-based cohort study compared the risk of incident nonproliferative diabetic retinopathy and retinopathy progression between SGLT2 inhibitors and GLP-1 receptor agonists in over 28,000 patients with CKD stages 3–4 and type 2 diabetes. After propensity score matching, neither outcome differed significantly between the two drug classes (incident NPDR: HR 0.98 [95% CI 0.87–1.10]; progression: HR 0.92 [95% CI 0.76–1.12]). These findings reassure clinicians managing cardiometabolic and renal comorbidities that both drug classes carry comparable retinal safety profiles, supporting flexible choice based on renal and cardiovascular indications rather than retinopathy concerns.

## Abstract (original, from the publication)

RATIONALE & OBJECTIVE: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) have demonstrated renal and cardiovascular benefits among patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). However, their comparative effects on diabetic retinopathy (DR) outcomes in patients with CKD stages 3-4 and T2D remain unclear. This study aimed to demonstrate the effect of SGLT2i vs GLP1RA in this population. STUDY DESIGN: Population-based, new-user, active comparator cohort study comparing SGLT2i versus GLP1RA initiators. Subjects were divided into 2 cohorts: (1) incident nonproliferative diabetic retinopathy (NPDR) and (2) DR progression cohort. SETTING & STUDY POPULATION: Patients with CKD stages 3-4 and T2D across 3 US health care databases: Optum's de-identified Clinformatics Data Mart Database (2014-2024), Merative MarketScan (2014-2022), and Medicare Fee-for-Service (2014-2020). SELECTION CRITERIA FOR STUDIES: Adults with a new prescription for either SGLT2i or GLP1RA without prior use in the preceding 365 days. The primary outcomes were incident NPDR and DR progression, identified through ICD-9/10 diagnosis codes and procedural codes for retinopathy treatments. DATA EXTRACTION: Exposures, covariates, and outcomes were obtained from structured claims fields. ANALYTICAL APPROACH: Both cohorts were analyzed using propensity score matching (1:1) to control for confounding. Incidence rates (IRs), rate differences, and hazard ratios (HRs) were calculated. RESULTS: After 1:1 propensity score matching, the study included 20,135 matched patient pairs in the incident NPDR cohort and 7,763 matched pairs in the DR progression cohort. For incident NPDR, there was no difference between SGLT2i and GLP1RA groups (IR 29.55 vs 30.38 per 1,000 person-years, respectively; HR 0.98 [95% CI, 0.87-1.10]). Similarly, DR progression was not different between groups (IR 32.73 vs 35.24 per 1,000 person-years; HR 0.92 [95% CI, 0.76-1.12]). Subgroup analyses showed no differences in HRs for both incident NPDR and DR progression across multiple predefined subgroups. LIMITATIONS: Potential for residual confounding, outcome misclassification, and limited generalizability to non-U.S. populations. CONCLUSIONS: Initiation of SGLT2i was not associated with a different risk of incident NPDR or DR progression compared with GLP1RA among patients with CKD stages 3-4 and T2D. Additional studies with extended follow-up are needed to better characterize long-term retinal safety profiles of these therapies.

Auteurs: Panupong Hansrivijit, Elisabetta Patorno, Helen Tesfaye, Deborah J Wexler, Miin Roh, Julie M Paik

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Bron: Kidney medicine, https://doi.org/10.1016/j.xkme.2026.101518. Bijgewerkt 2026-10-28T02:16:21Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.