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Kidney Week

Abstract: PO2184

A Possible Effect of Glucagon-Like Peptide 1 Receptor Enhancement on Graft Kidney Function

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Sato, Tetsuhiko, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Azuma, Yoshinori, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Otsuka, Yasuhiro, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Goto, Norihiko, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Narumi, Shunji, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Takeda, Asami, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Hiramitsu, Takahisa, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Okada, Manabu, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Osako, Kiyomi, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
  • Watarai, Yoshihiko, Nagoya Daini Sekijuji Byoin, Nagoya, Aichi, Japan
Background

Successful kidney transplantation (KTX) has revolutionary improved comorbidities related to diabetic kidney disease in type 2 diabetic patients. Enormous evidence has accumulated that incretin enhancer, glucagon-like peptide 1 receptor agonists (GLP-1RAs) have potential to boost native kidney function. However, little is known about a possible protective effect of its use on graft kidney function.

Methods

We conducted an observational cohort study to investigate the association between the use of GLP-1RA versus other antidiabetic medications (Non-GLP-1RA), and the 4-year risk of sustained eGFR decline (4 straight month-40% decrease from baseline) in consecutive kidney transplant recipients (KTRs) with type 2 diabetes who underwent KTX in our center from January 2012 through December 2018. Included were all KTRs with type 2 diabetes who were followed forward in time from month 1 post-transplant for 24 months or longer at the time of December 31, 2020. We calculated the propensity score of initiating GLP-1RA versus Non-GLP-1RA as a function of baseline covariates using logistic regression. Inverse probability of treatment weighting was generated from the propensity score and treatment-weighted odds ratio was estimated between the two treatment groups to better control for baseline confounding variables including presence or absence of protocol biopsy-proven interstitial fibrosis/tubular atrophy 1 month after KTX. Sodium-glucose cotransporter 2 inhibitors medication was treated as competing event.

Results

Seventy three were identified as GLP-1RA users, 73 were on Non-GLP-1RA medications, and no deaths with graft function were observed during the study period. There were 6 sustained eGFR decliners in Non-GLP-1RA group whereas 1 in GLP-1RA group.
According to multivariate analysis, GLP-1RA use after KTX was associated with a lower risk of sustained eGFR reduction (weighted odds ratio, 0.105; 95% confidence interval, 0.012-0.961).

Conclusion

GLP-1RA initiation and continuous use had a lower eGFR decline compared with other antidiabetic medications and may contribute to better kidney graft survival after KTX.