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Kidney Week

Abstract: TH-PO0367

Evaluating the Safety and Efficacy of GLP-1 Receptor Agonists in Kidney Transplant Recipients with Diabetic Nephropathy

Session Information

Category: Diabetic Kidney Disease

  • 702 Diabetic Kidney Disease: Clinical

Authors

  • Berrian, Katherine N, University of Colorado System, Aurora, Colorado, United States
  • Jensen, Tom, University of Colorado System, Aurora, Colorado, United States
  • Brosi, Deena, University of Colorado System, Aurora, Colorado, United States
  • Giusti, Sixto G., University of Colorado System, Aurora, Colorado, United States
Background

GLP-1 receptor agonists (GLP-1RA) are increasingly being prescribed in obese and diabetic patients to promote weight loss and glycemic control. However, their safety in kidney transplant recipients (KTR) with diabetic nephropathy is unknown. We aim to identify the safety of early initiation of GLP-1RA in KTR.

Methods

We included 37 adult KTR enrolled at UCHealth diabetes clinic; 16 KTR were prescribed GLP-1RA and 21 KTR without GLP-1RA for controls. We collected data using continuous glucose monitors (CGM). For categorical clinical measures we report proportion and sample size and for continuous clinical measures report median and inter-quartile range. Measures were recorded at study inclusion (baseline), 90-days, and 180-days post-baseline. For users, baseline was start of GLP-1RA and for controls was 65 days post kidney transplant. For statistical analysis we conducted Fischer’s exact test and Mann-Whitney U tests. Analyses were performed in RStudio/2024.12.0.

Results

Among 37 KTR, there was similar glycemic control in patients prescribed GLP-1RA (N=16) compared to patients without GLP-1RA (N=21). Median time in range (BG 70-180 mg/dL) was similar between users and non-users at 90 days (59% vs. 60%, p=0.74) and at 180 days (67% vs. 60%, p=0.47). Hypoglycemic events were negligible in both groups. Median A1C between users and non-users were similar at 90 (7.60% vs. 7.40%, p=0.45), and 180 days (6.90% vs. 7.00%, p=1.00). There were no statistically significant differences in eGFR between users and non-users at 90 (62 vs. 68 mL/min/1.73m2, p=0.81) and 180 days (66 vs. 63 mL/min/1.73m2, p=0.53). Median tacrolimus levels were stable in both groups at 90 (9.10 ng/mL vs. 9.30 ng/mL, p=0.35), and 180 days (9.00 ng/mL for both groups, p=0.87). Weight at 90 days was higher in GLP-1RA users (p=0.009) but was insignificantly different at 180 days. Changes in weight from baseline suggest weight loss in users and weight gain in controls.

Conclusion

Our findings indicate similar glycemic control without increased risk of hypoglycemia and comparable renal function in early GLP-1RA use in KTR. GLP-1RA users also exhibited trends toward weight loss. These results support the safety of early initiation of GLP-1RA in KTR, highlighting potential as a non-inferior therapy for patients with diabetes.

Digital Object Identifier (DOI)