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Kidney Week

Abstract: SA-PO482

Predictors and Outcomes of Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 RAs) in CKD

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Gregg, L Parker, Baylor College of Medicine, Houston, Texas, United States
  • Richardson, Peter, Michael E DeBakey VA Medical Center, Houston, Texas, United States
  • Nambi, Vijay, Baylor College of Medicine, Houston, Texas, United States
  • Matheny, Michael Edwin, Vanderbilt University Medical Center, Nashville, Tennessee, United States
  • Virani, Salim S., The Aga Khan University, Karachi, Sindh, Pakistan
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
Background

GLP-1 RAs improve cardiovascular and kidney outcomes in patients with CKD but are underutilized. We aimed to study treatment discontinuation and its associations with patient-level characteristics and death among those with CKD.

Methods

Adults with CKD stages 3-4 were identified from the Veterans Affairs (VA) Corporate Data Warehouse from 2005-2022. Individuals who had an incident prescription for a GLP-1 RA were included, with the date of prescription used as the index date for the analysis. The primary outcome was treatment discontinuation, defined as an interruption in GLP-1 RA prescription for at least 90 days. Cox proportional hazards regression identified factors associated with time to treatment discontinuation and the association of treatment discontinuation with time to all-cause death, treating GLP-1 RA discontinuation as a time-varying covariate.

Results

Of 60,020 individuals who received a GLP-1 RA, 95% were male, 75% were White, 20% were Black, 63% were of age ≥70, and 80% had CKD stage 3a. Discontinuation (at least once) occurred in 28,407 (47%) GLP-1 RA users over a median (IQR) of 1.41 (0.72, 2.59) years of follow up. Black or unreported race, younger age, and concomitant vascular disease were associated with GLP-1 RA discontinuation (Figure). There were 9628 deaths. GLP-1 RA discontinuation, included as a time-varying covariate, was associated with all-cause death (HR 2.22 [95% CI 2.11, 2.34], P<0.0001) independent of age, sex, race, CKD stage, medical comorbidities, and concomitant medication use.

Conclusion

In CKD population, discontinuation of GLP-1RA is common and was associated with an increased risk of death. Additional studies exploring the reasons for short-term and long-term discontinuations of these agents are needed.

Funding

  • Other NIH Support