Division of Integrated Strategic Medicine, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan.
Division of Diabetes and Endocrinology, Japanese Red Cross Aichi Medical Center, Nagoya Daini Hospital, Nagoya, Aichi 4668650, Japan.
J Clin Endocrinol Metab. 2023 Sep 18;108(10):2597-2603. doi: 10.1210/clinem/dgad177.
Glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) have the potential to improve native kidney function.
This work aimed to elucidate the possible protective effects of GLP-1 RAs on kidney graft function after successful kidney transplantation (KTX).
This retrospective cohort study included all KTX recipients (KTRs) at our facility with type 2 diabetes who were followed up from 1 month post-transplantation for 24 months or longer as of December 31, 2020. We investigated associations between the use of GLP-1 RAs and other antidiabetic medications (non-GLP-1 RAs) and the risk of sustained estimated glomerular filtration rate (eGFR) reduction (40% reduction compared with baseline for 4 months) for KTRs with type 2 diabetes. We calculated the propensity score of initiating GLP-1 RAs compared with that of initiating non-GLP-1 RAs as a function of baseline covariates using logistic regression. The inverse probability of the treatment-weighted odds ratio was estimated to control for baseline confounding variables. Sodium-glucose cotransporter 2 inhibitor use was a competing event. The primary outcome was sustained eGFR reduction of at least 40% from baseline for 4 months post-transplantation.
Seventy-three patients were GLP-1 RA users and 73 were non-GLP-1 RA users. Six patients and 1 patient in the non-GLP-1 RA and GLP-1 RA groups had sustained eGFR reduction. GLP-1 RA use after KTX was associated with a lower risk of sustained eGFR reduction.
GLP-1 RAs resulted in lower eGFR reduction compared with non-GLP-1 RAs and may contribute to better kidney graft survival after KTX.
胰高血糖素样肽-1（GLP-1）受体激动剂（RAs）具有改善天然肾脏功能的潜力。
本研究旨在阐明 GLP-1 RAs 在成功肾移植（KTX）后对肾移植物功能的可能保护作用。
本回顾性队列研究纳入了我院所有患有 2 型糖尿病的 KTX 受者（KTRs），他们在移植后 1 个月开始随访，随访时间至少为 24 个月，截至 2020 年 12 月 31 日。我们调查了 GLP-1 RAs 和其他抗糖尿病药物（非 GLP-1 RAs）的使用与 2 型糖尿病 KTRs 持续估计肾小球滤过率（eGFR）下降（与基线相比 4 个月内下降 40%）的风险之间的关系。我们使用逻辑回归根据基线协变量计算起始 GLP-1 RA 与起始非 GLP-1 RA 的倾向评分。使用治疗加权反概率比估计了逆概率以控制基线混杂变量。钠-葡萄糖共转运蛋白 2 抑制剂的使用是一个竞争事件。主要结局是移植后 4 个月内 eGFR 持续下降至少 40%，与基线相比。
73 例患者为 GLP-1 RA 使用者，73 例为非 GLP-1 RA 使用者。非 GLP-1 RA 组和 GLP-1 RA 组各有 6 例和 1 例患者发生持续 eGFR 下降。KTX 后使用 GLP-1 RA 与持续 eGFR 下降的风险较低相关。
与非 GLP-1 RA 相比，GLP-1 RA 导致 eGFR 下降幅度较小，可能有助于 KTX 后更好的肾移植物存活。
