Tight glycemic control has been demonstrated to reduce the incidence of microvascular complications in type 1 and 2 diabetes. However, tight control comes at a risk of hypoglycemia, which is further increased in advanced diabetic kidney disease. GLP-1 agonists significantly lower HgA1c and have added benefits of early satiety and weight loss. However, the safety and efficacy of these agents has not been well documented in CKD stage 3-4.
This is a retrospective case series of patients with diabetes and CKD stages 3-4 who were prescribed a GLP-1 agonist. Patient demographics, co-morbidities, vital signs, HgA1c, Scr, eGFR, urine protein to creatinine ratio (UPC) as measured during clinical care were recorded before and after GLP-1 agonist initiation.
A total of 5 patients with diabetes and CKD stage 3-4 were included in this case series. Two patients received exenatide, two liraglutide and one received dulaglutide. Patients were 66.9 years old (47.7-77.6) with the majority being male (60%) and caucasian ethnicity (80%). The median number of co-morbidities was 8 (5-14) with hypertension, hyperlipidemia and cardiovascular complications most common. The median HgA1c at initiation of therapy was 8.3% (8-10.1) and the reduction in HgA1c was 2.2% (0.8-3). The median BMI at initiation of a GLP-1 agonist was 34.3 (27.8-36) kg/m2 and the median decrease in BMI over the duration of therapy was 1 (-0.32-5.7) kg/m2 and the median decrease in BMI over the duration of therapy was 1 (-0.32-5.7) kg/m2 and the median decrease in BMI over the duration of therapy was 1 (-0.32-5.7) kg/m2. The eGFR at initiation of t. The eGFR at initiation of t. The eGFR at initiation of therapy was 46 (29-48) mL/min/1.73 m2 and remained relatively stable over the duration of therapy. The median UPC was 0.21 (0.007-8.39) with a median reduction of 0.11 (-0.05-6.13).<
Overall, each of the GLP-1 agonists was effective in safely reducing HgA1c in older patients with type 2 diabetes and Stage 3-4 CKD without significantly impacting eGFR. Further studies are warranted to validate these findings.