#3819 Comparative effects of GLP-1RAs on kidney transplant recipients and chronic kidney disease patients

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Abstract Background and Aims There is limited information regarding the safety and effectiveness of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in kidney transplant recipients, a group at elevated risk for diabetes and its associated complications. Outcomes have not been compared with those of patients with chronic kidney disease (CKD). Method This retrospective cohort study included all kidney transplant recipients at our tertiary hospital who received GLP-1RA treatment and were followed for 24 months or longer. Measurements of glomerular filtration rate (eGFR), proteinuria, BMI, HbA1c, cholesterol, and clinical variables including treatments and side effects were recorded at baseline and at follow-up intervals of 1, 3, 6, 12, 18, and 24 months. We investigated associations between GLP-1RA treatment and its impact on eGFR and proteinuria reduction. A matched cohort of patients with CKD was enrolled to compare outcomes with those of kidney transplant recipients. Results We enrolled 52 kidney transplant recipients who received GLP-1RA treatment. The majority were male (65.38%), with a mean age of 58.04 years. Hypertension was present in 82.69% of patients, 61.54% had type 2 diabetes, and 17.31% developed new-onset diabetes after kidney transplantation. At the start of treatment, the mean eGFR was 77.48 ± 18.94 ml/min/1.73 m², and the median uPCR was 258 mg/g (IQR: 6–622). The mean eGFR at 6 and 12 months was 76.59 ± 19.97 ml/min/1.73 m² and 80.85 ± 20.16 ml/min/1.73 m², respectively. During follow-up, a non-significant mean annual eGFR decline of 0.34-ml/min/1.73 m² per year was observed. The median reduction in proteinuria during the first year was 14.58%, with a sharper decline observed during the first 6 months (33.63%) compared to 5.77% at 12 months. In the CKD group, the reduction in proteinuria during the first year was higher (30.93%; P = 0.28). At treatment initiation, kidney transplant recipients had a mean HbA1c of 7.3%, with 23 patients initially having an HbA1c above 7.5%. After 6 months, this number decreased to 13 patients, and at 12 months, it dropped further to seven patients. The median reduction in HbA1c was non-significant at 6 months (0.15%), but significant at 12 months (0.5%; IQR: 0.2–1.1), and 0.6% at 24 months (IQR: 0–1.1). In the kidney transplant group, the mean BMI at baseline was 34.05 ± 4.14, and patients experienced an average body weight loss of 4.3 kg over the first 12 months, compared to 5.59 kg in the CKD group (P = 0.62). Eight kidney transplant recipients experienced adverse events, seven of which were mild (nausea and diarrhea), while one patient died from necrotizing pancreatitis. Conclusion GLP-1RA treatment in kidney transplant recipients led to improvements in proteinuria, HbA1c, and body weight, with non-significant changes in eGFR over the first year. The effects were more noticeable during the first 6 months of treatment. Compared to patients with CKD, kidney transplant recipients experienced more modest beneficial effects from GLP-1RA, which could be related to the harmful effects of immunosuppressants and prednisone. Although mild adverse events were reported in some patients, the treatment was generally well tolerated, with only one fatal complication.

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