Glucagon-like peptide 1 receptor agonists and renal outcomes in kidney transplant recipients with diabetes mellitus

Feb 17, 2025Diabetes & metabolism

Glucagon-like peptide 1 drugs and kidney health after transplant in people with diabetes

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Abstract

The use of GLP1-RAs is associated with 68 events per 1000-patient years in diabetic kidney transplant recipients compared to 114 events in non-users.

GLP1-RAs may lower the incidence of composite renal outcomes, including graft rejection and all-cause mortality.
Users of GLP1-RAs demonstrated improved glycemic control and lipid profiles.
There was a decrease in body mass index among GLP1-RA users.
The treatment did not lead to an increase in genitourinary infections or biliopancreatic adverse events.
Further prospective data is needed to confirm these findings in diabetic kidney transplant recipients.

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AIMS: Glucagon-like peptide-1 receptor agonists (GLP1-RAs) show reno-protective effects in type 2 diabetes. Limited data is available on their use in post-transplant diabetes mellitus. We aimed to explore the effect of GLP1-RAs on renal outcomes in diabetic kidney transplant recipients (KTR).

METHODS: We conducted a cohort retrospective study on adult KTR with diabetes mellitus. KTR treated with GLP1-RAs were matched with non-users. The primary outcome was the first occurrence of graft rejection, start of dialysis, re-transplantation or all-cause mortality. Other outcomes included a composite of the first occurrence of a genitourinary infection or all-cause mortality, and all-cause mortality. Metabolic effects of GLP1-RA treatment and risk for biliopancreatic adverse events were also explored.

RESULTS: We included 272 patients (69 % males, average age 58.3 ± 11.0 years) with a 3.1-year median follow-up. The use of GLP1-RAs lowered the incidence of the composite renal outcome after adjustment for independent risk factors (114 versus 68 events per 1000-patient years in controls versus GLP1-RA users, HR 0.489, 95 % CI 0.271-0.883). GLP-RA users had improved glycemic control, lipid profile and a decrease in body mass index. The treatment was safe without increased genitourinary infections or biliopancreatic events.

CONCLUSION: The use of GLP1-RAs decreased the risk of a composite outcome of renal dysfunction and mortality, improved metabolic control and showed safety of use in a large cohort of diabetic KTR, suggesting reno-protective effects in this high-risk population. Prospective data is further needed in KTR who are excluded from large RCTs.

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Glucagon-like peptide 1 receptor agonists and renal outcomes in kidney transplant recipients with diabetes mellitus

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