Department of Internal Medicine & Kidney Research Institute, Hallym University Sacred Heart Hospital, Anyang, Korea.
Department of Internal Medicine & Kidney Research Institute, Kangnam Sacred Heart Hospital, Seoul, Korea.
PLoS One. 2022 Aug 12;17(8):e0273004. doi: 10.1371/journal.pone.0273004. eCollection 2022.
Dulaglutide is associated with improved cardiovascular and kidney outcomes and can be a good therapeutic option for patients with type 2 diabetes with chronic kidney disease (CKD). In this study, the effects of dulaglutide on glucose-lowering efficacy and changes in renal function were analyzed.
This retrospective study involved 197 patients with type 2 diabetes with mild-to-severe CKD treated with dulaglutide for at least 3 months between January 2017 and December 2020 at two tertiary hospitals in Korea. Changes in the creatinine-based estimated glomerular filtration rate (eGFR) and HbA1c were compared before and after the use of dulaglutide in each patient.
The number of patients and mean eGFR (mL/min/1.73 m2) in CKD 2, 3a, 3b, and 4 were 94 (75.0 ± 8.5), 46 (54.8 ± 6.3), 31 (38.8 ± 4.4), and 26 (22.5 ± 5.4), respectively. Mean HbA1c level and body mass index (BMI) at the initiation of dulaglutide were 8.9% ± 1.4% and 29.1 ± 3.6 kg/m2, the median duration of the use of dulaglutide was 16 months. The use of dulaglutide was associated with a mean decrease in HbA1c by 0.9% ± 1.5% and the glucose-lowering efficacy was similar across all stages of CKD. Also, it was associated with a reduced decline in the eGFR; the mean eGFR change after the use of dulaglutide was -0.76 mL/min/1.73 m2 per year, whereas it was -2.41 mL/min/1.73 m2 before use (paired t-test, P = 0.003). The difference was more pronounced in patients with an eGFR < 60 mL/min/1.73 m2. Subgroup analysis showed that the renal protective effect was better in patients with proteinuria, age ≤ 65 years, and HbA1c < 9.0%, but showed no association with BMI.
The use of dulaglutide provided adequate glycemic control irrespective of CKD stage and was associated with a reduced decline in the eGFR in the CKD population.
度拉糖肽可改善心血管和肾脏结局，对于合并慢性肾脏病（CKD）的 2 型糖尿病患者而言，是一种很好的治疗选择。本研究旨在分析度拉糖肽在降糖疗效和肾功能变化方面的作用。
本回顾性研究纳入了 2017 年 1 月至 2020 年 12 月期间在韩国的两家三级医院接受至少 3 个月度拉糖肽治疗的 197 例合并轻至重度 CKD 的 2 型糖尿病患者。比较每位患者使用度拉糖肽前后基于肌酐的估算肾小球滤过率（eGFR）和糖化血红蛋白（HbA1c）的变化。
CKD 2 期、3a 期、3b 期和 4 期的患者人数和平均 eGFR（mL/min/1.73 m2）分别为 94 例（75.0±8.5）、46 例（54.8±6.3）、31 例（38.8±4.4）和 26 例（22.5±5.4）。度拉糖肽起始时的平均 HbA1c 水平和体重指数（BMI）分别为 8.9%±1.4%和 29.1±3.6 kg/m2，度拉糖肽的中位使用时间为 16 个月。使用度拉糖肽可使 HbA1c 平均降低 0.9%±1.5%，且降糖疗效在 CKD 的各个阶段相似。此外，它与 eGFR 下降幅度减小有关；使用度拉糖肽后 eGFR 的平均变化为每年-0.76 mL/min/1.73 m2，而使用前为-2.41 mL/min/1.73 m2（配对 t 检验，P=0.003）。在 eGFR＜60 mL/min/1.73 m2 的患者中，差异更为显著。亚组分析显示，在蛋白尿、年龄≤65 岁和 HbA1c＜9.0%的患者中，度拉糖肽具有更好的肾脏保护作用，但与 BMI 无关。
在 CKD 人群中，使用度拉糖肽可实现充分的血糖控制，且与 eGFR 下降幅度减小有关。
