Tirzepatide improves kidney-related outcomes compared to dulaglutide in high-risk patients with type 2 diabetes, analysis suggests
Presenter: Sophia Zoungas, PhD, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
Tirzepatide vs. dulaglutide is associated with reduced major kidney events in patients with type 2 diabetes, CVD, and very high-risk kidney diseases. Abstract FR-OR087. Presented November 7, 2025.
Compared with dulaglutide, tirzepatide was associated with better kidney-related outcomes, according to an analysis of the SURPASS-CVOT (Study of Tirzepatide Compared With Dulaglutide on Major Cardiovascular Events in Participants With Type 2 Diabetes) trial presented at American Society of Nephrology Kidney Week 2025.
Tirzepatide, a dual agonist of the gastric inhibitory polypeptide and glucagon-like peptide 1 receptors, reduced decline in kidney function versus dulaglutide, a glucagon-like peptide 1 receptor agonist, in patients with type 2 diabetes, atherosclerotic cardiovascular disease, and very high-risk chronic kidney disease.
Tirzepatide also reduced progression of albuminuria, as well as risk of a composite kidney outcome in this patient population, according to the study results, which were presented as an oral abstract in session highlighting high-impact clinical trials.
“These findings demonstrate the potential for benefits of tirzepatide when treating high-risk patients,” said corresponding author Sophia Zoungas, PhD, of Monash University, in Australia.
This new analysis extends the findings of SURPASS-CVOT, a head-to-head trial of tirzepatide versus dulaglutide in adults with type 2 diabetes and atherosclerotic cardiovascular disease.
Previously in SURPASS-CVOT, tirzepatide met the primary objective of noninferiority in the rate of major adverse cardiovascular events, it was reported in July of this year.
The risk of cardiovascular death, myocardial infarction, or stroke was 8% lower with tirzepatide versus liraglutide (hazard ratio 0.92, 95% confidence interval 0.83–1.01), which met prespecified criteria for noninferiority.
In this latest analysis of SURPASS-CVOT, shown at Kidney Week, investigators focused on outcomes after 36 months of treatment in participants with very high-risk chronic kidney disease.
The 2025 Kidney Disease: Improving Global Outcomes guidelines define very high-risk chronic kidney disease as an estimated glomerular filtration rate less than 30 mL/min/1.73 m2, or 30 to less than 45 mL/min/1.73 m2 with micro- or macroalbuminuria, or 45 to less than 60 mL/min/1.73 m2 with macroalbuminuria.
A total of 1,241 patients met these criteria for very high-risk chronic kidney disease. Their mean age was 68.5 years, mean body mass index 33.0 kg/m2, mean hemoglobin A1c 8.5%, and mean duration of diabetes 19.2 years. About one-fourth were taking sodium-glucose cotransporter 2 inhibitors.
At 36 months, the mean estimated glomerular filtration rate had declined by 3.0 mL/min/1.73 m2 in the tirzepatide group, compared with 7.2 mL/min/1.73 m2 with dulaglutide, a statistically significant difference. Also at 36 months, the tirzepatide group had significantly less albuminuria, the investigators said.
The risk of a composite kidney outcome was 33% lower with tirzepatide versus dulaglutide treatment (hazard ratio 0.67, P = .002), according to the reported results.
While dulaglutide has established cardiovascular benefit, it is expected that SURPASS-CVOT will eventually provide definitive evidence of tirzepatide’s cardiovascular safety and efficacy versus dulaglutide, according to a 2024 report on the study in the American Heart Journal.
The SURPASS-CVOT will add important new information on application of incretin-based drugs to mitigate the cardiovascular complications of type 2 diabetes, authors said in that report.
Disclosures
Sophia Zoungas, PhD, and co-authors reported commercial support from Eli Lilly and Company.
References
Zoungas S, Nicholls S, Miller DL, et al. Tirzepatide vs. dulaglutide is associated with reduced major kidney events in patients with type 2 diabetes, CVD, and very high-risk kidney diseases [abstract]. Presented at: American Society of Nephrology Kidney Week 2025; November 6–9, 2025; Houston, TX.
Nicholls SJ, Bhatt DL, Buse JB, et al. Comparison of tirzepatide and dulaglutide on major adverse cardiovascular events in participants with type 2 diabetes and atherosclerotic cardiovascular disease: SURPASS-CVOT design and baseline characteristics. Am Heart J 2024; 267:1–11. doi:10.1016/j.ahj.2023.09.007