Evidence map›Paper›PMID 42632571›Full record

ArticleJournal of affective disorders2026

SGLT2 inhibitors versus GLP-1 receptor agonists and risk of kidney replacement therapy and healthcare utilization in bipolar disorder with chronic kidney disease: An active-comparator, new-user cohort study.

Balwinder Singh, Feyza Yaylaci, Hossam M Ali, Ritika Baweja, Maria L Gonzalez Suarez, Raman Baweja

Abstract readComparative Study
In one paragraph

Article in Journal of affective disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Balwinder SinghDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. Electronic address: singh.balwinder@mayo.edu.
Feyza YaylaciDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Hossam M AliDepartment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
Ritika BawejaDepartment of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.
Maria L Gonzalez SuarezDivision of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Raman BawejaDepartment of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA.

Funding

Penn State Clinical and Translational Science InstituteUL1TR002014 · NCATS · PENNSYLVANIA STATE UNIV HERSHEY MED CTR · PI KRASCHNEWSKI, JENNIFER L. · 2016 to 2025
$33.7M
Institutional Career Development CoreKL2TR002379 · NCATS · MAYO CLINIC ROCHESTER · PI NILUFER ERTEKIN-TANER · 2017 to 2026
$14.9M
A novel use of web-based software to efficiently triage pre-surgical patients basR44TR000045 · NCATS · MEDSLEUTH, INC. · PI KALAMAS, ALICIA GRUBER · 2012 to 2012
$546k
NCATS NIH HHS KL2 TR002379NCATS NIH HHS R44 TR000045NCATS NIH HHS UL1 TR002014
6 · The paper itself

Abstract

Individuals with bipolar disorder (BD) face elevated rates of chronic kidney disease (CKD) and premature mortality yet remain underrepresented in cardiorenal trials. Although sodium-glucose cotransporter-2 inhibitors (SGLT2is) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have established renoprotective benefits in the general population, their comparative effectiveness in BD with comorbid CKD is unknown. This active-comparator, new-user cohort study examined risks of kidney replacement therapy (KRT) and healthcare utilization (HCU) (inpatient hospitalization and emergency department visits) among adults with BD and CKD stages 1-3 initiating SGLT2i versus GLP-1 RA. Electronic health record data from the TriNetX network (2014-July 2026) identified eligible adults with documented treatment prescriptions; 3971 SGLT2i and 5608 GLP-1 RA users were identified, with 1:1 propensity score matching (PSM) yielding 2557 patients per arm. Cox proportional hazards regression generated adjusted hazard ratios (aHR) in the full cohort; Kaplan-Meier analyses were conducted in the matched cohort. In full cohort, SGLT2i use was associated with non-significantly lower KRT risk (aHR 0.87, 95% CI 0.71-1.06) and slightly higher HCU risk (aHR 1.18, 95% CI 1.10-1.28) relative to GLP-1 RA. In the matched cohort, 132 of 2557 SGLT2i users and 181 of 2557 GLP-1 RA users experienced KRT, with a borderline, non-significant difference favoring SGLT2i (86.88% vs. 83.48%; p = 0.06). For HCU, 990 of 2557 SGLT2i users and 965 of 2557 GLP-1 RA users experienced the outcome; 5-year HCU-free survival was slightly higher for SGLT2i users than GLP-1 RA users (36.42% vs. 33.27%; p = 0.004), reflecting convergence and late crossover of the Kaplan-Meier curves despite SGLT2i's higher hazard over most of the follow-up period. Residual confounding cannot be excluded, and competing mortality risk may have attenuated the observed hospitalization difference. Among patients with BD and CKD, SGLT2i use showed a non-significant trend toward lower KRT risk but was associated with significantly higher healthcare utilization compared with GLP-1 RA in the full cohort. Confirmation in prospective registries, large longitudinal studies, and randomized trials is needed.

Indexed as

Bipolar DisorderGlucagon-Like Peptide-1 Receptor AgonistsPatient Acceptance of Health CareRenal Insufficiency, ChronicRenal Replacement TherapySodium-Glucose Transporter 2 InhibitorsAdultAgedCohort StudiesFemaleHumansMaleMiddle AgedGlucagon-Like Peptide-1 Receptor AgonistsSodium-Glucose Transporter 2 InhibitorsBipolar disorderChronic kidney diseaseGLP-1 receptor agonistsKidney replacement therapySGLT-2 inhibitors

Identifiers

PMID42632571
PMCPMC13561641

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.