6624 EFFICACY AND SAFETY OF GLP1 ANALOGUES IN ADVANCED CKD PATIENTS: A POTENTIAL STRATEGY FOR WEIGHT LOSS AND INCLUSION IN RENAL TRANSPLANT WAITING LIST

• Published in: Nephrology, dialysis, transplantation Vol. 38; no. Supplement_1
• Main Authors: Alonso, Marta, Sánchez, Luis Alberto Vigara, Fernández, Florentino Villanego, Amaro, Jose Manuel, Aguilera, Aurora, Singh, Arshdeep, Muñoz, Javier Naranjo, López, Juan Manuel Cazorla, Mejía, Carlos Narváez, Orellana, Cristhian, Masero, Julia Torrado
• Format: Journal Article
• Language: English
• Published: 14.06.2023
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfad063c_6624

Abstract Background and Aims Diabetes mellitus (DM) is one of the main causes of chronic kidney disease (CKD) and the need for renal replacement therapy. New antidiabetic drugs such as glucagon-like peptide type 1 receptor analogues (aGLP1) improve glycemic control and cardiovascular risk and promote weight loss. Our main objective was to analyze the efficacy and safety of aGLP1 agonists in patients with advanced chronic kidney disease (ACKD). Method Prospective cohort study of CKD (estimated glomerular filtration rate (eGFR) ≤30 ml/min) and DM2 patients who started treatment with aGLP1 between April 2018 and November 2022. We analyzed clinical and demographic variables. We collected aGLP1 type and dose, eGFR and weight at baseline and after 6 and 12 months of treatment. We analyzed glycemic and lipid control and blood pressure (BP). We documented adverse effects. Descriptive analysis was performed and we compared eGFR before and after aGLP1 initiation. Results During the period 36 patients with ACKD started treatment with aGLP1 in our center, 30 with a minimum follow-up of 6 months. 66.7% were male and the mean age was 67. 88.9% were hypertensive and 91.7% dyslipidemic. 33.3% had a history of ischemic heart disease, 11.1% heart failure, 41.7% peripheral arterial disease and 8.3% stroke. The mean eGFR at drug initiation was 20.7 mL/min. The most frequent cause of CKD was diabetic nephropathy (66.7%) followed by glomerulonephritis (11.1%). Mean weight was 92.7±9.7 kg and BMI 33.15±3.2 kg/m2. The most prescribed aGLP1 was Semaglutide (83.4%) followed by Liraglutide (13.9%) and Dulaglutide (2.8%). Maximum drug dose was reached in 69.4% of patients. After initiation, eGFR remained stable at 6 months and 1 year (p = .424). We observed a 12% reduction in weight at one year after treatment (94Kg vS 83Kg; p<.001). We found no differences in glycosylated hemoglobin, lipid control and BP at 6th month and first year. Two patients suffered gastrointestinal adverse effects and one discontinued the drug because of this. One patient died during follow-up of independent cause. Conclusion aGLP1 in patients with ACKD are safe. Adverse effects do not occur more frequently than in the non-CKD population. In addition to improving cardiovascular risk of patients, they can produce a weight loss that can independently help patients to be included in the waiting list for renal transplantation.