Abstract: FR-PO1115
GLP-1 Receptor Agonist Exposure and Longitudinal Outcomes in Patients with Type 2 Diabetes Initiating Peritoneal Dialysis
Session Information
- Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Luo, Jiacong, DaVita Inc, Denver, Colorado, United States
- Sibbel, Scott, DaVita Inc, Denver, Colorado, United States
- Weinhandl, Eric D., DaVita Inc, Denver, Colorado, United States
- Tentori, Francesca, DaVita Inc, Denver, Colorado, United States
- Brunelli, Steven M., DaVita Inc, Denver, Colorado, United States
Background
Peritoneal dialysis (PD) patients with type 2 diabetes (T2D) experience cardiovascular risk and substantial metabolic burden from dialysate glucose exposure and progressive loss of residual kidney function. A recent clinical trial showed glucagon-like peptide-1 receptor agonist (GLP-1RA) Semaglutide reduced the risk of death from cardiovascular causes in patients with T2DM and chronic kidney disease (CKD) (FLOW, Perkovic 2024 NEJM). Evidence regarding GLP-1RA use in PD populations remains limited.
Methods
We conducted a retrospective cohort study among 5,897 adults with T2D initiating PD between April 2021 and September 2024; 516 (8.7%) initiated a GLP-1RA. Patients were followed from day 90 after PD start, and patient time assigned to GLP-1RA use vs. control based on prescription data. Marginal structural models (MSM) estimated the average treatment effect in the overlap population using stabilized inverse probability weights for time-varying treatment assignment and censoring. Outcomes included relative weight change (primary), hospitalization, BSA-indexed ultrafiltration, and urine output (secondary), and HbA1c and mortality (exploratory).
Results
Increasing cumulative GLP-1RA exposure was associated with progressive weight reduction (−1.19 percentage points [pp], 95% CI −1.97 to −0.42; p=0.003), with dose-response effects (−0.73 pp per exposure quarter, p<0.001). Findings strengthened under new-user restriction (−1.69 pp, p<0.001). Hospitalization analyses demonstrated lower modeled hospitalization burden with increasing cumulative exposure (IRR=0.935 per exposure quarter, p=0.004). BSA-indexed ultrafiltration and urine output demonstrated no significant associations. Mortality estimates were directionally protective but imprecise (HR=0.706, p=0.33). HbA1c analyses violated parallel trend assumptions and were interpreted descriptively because of confounding by indication.
Conclusion
In incident PD patients with T2D, increasing cumulative GLP-1RA exposure was associated with progressive weight reduction and lower modeled hospitalization burden under longitudinal MSM assumptions. Mortality estimates were directionally protective but imprecise. Prospective studies are needed to confirm long-term effects in PD populations.