Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipients
Introduction: In kidney transplant (KT) recipients diabetes mellitus (DM) are associated with an increased mortality and a poorer graft survival. Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in the general population. However, there is lacki...
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Elsevier
2024-11-01
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| Series: | Nefrología (English Edition) |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2013251424002062 |
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| author | Luis Alberto Vigara Florentino Villanego Cristhian Orellana Myriam Eady María Gabriela Sánchez Marta Alonso María Belén García José Manuel Amaro Teresa García Auxiliadora Mazuecos |
| author_facet | Luis Alberto Vigara Florentino Villanego Cristhian Orellana Myriam Eady María Gabriela Sánchez Marta Alonso María Belén García José Manuel Amaro Teresa García Auxiliadora Mazuecos |
| author_sort | Luis Alberto Vigara |
| collection | DOAJ |
| description | Introduction: In kidney transplant (KT) recipients diabetes mellitus (DM) are associated with an increased mortality and a poorer graft survival. Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in the general population. However, there is lacking evidence in KT recipients. Objective: To analyze the efficacy and safety of glucagon-like peptide 1 receptor GLP1-RA in a cohort of KT recipients. Methods: Multicenter retrospective cohort study of KT patients with DM who started subcutaneous GLP1-RA in 3 hospitals in the province of Cádiz between February 2016 and July 2022. Estimated glomerular filtration rate (eGFR), proteinuria, and weight at baseline and after 6 and 12 months were collected. We analyzed glycemic control, blood pressure, lipid profile, and doses and trough levels of tacrolimus. We document episodes of acute rejection (AR), de novo donor-specific antibodies (dnDSA), and adverse effects. Results: During this period, 96 KT with DM started treatment with GLP1-RA, of which 84 had a minimum follow-up of 6 months and 61 were followed for 12 months. A significant reduction was observed in proteinuria (−19.1 mg/g, p = 0.000; −46.6 mg/g, p = 0.000), weight (−3.6 kg, p = 0.000; −3.6 kg, p = 0.000), glycosylated hemoglobin (−0.7%, p = 0.000; −0.9%, p = 0.000), systolic blood pressure (−7.5 mmHg, p = 0.013; −7.3 mmHg, p = 0.004), total cholesterol (−11.5 mg/dL, p = 0.001; −15.6 mg/dl, p = 0.002) and LDL cholesterol (−9.2 mg/dl, p = 0.002; −16.8 mg/dl, p = 0.000) at 6 months and 1 year of follow-up. The eGFR remained stable and the dose and trough levels of tacrolimus did not change. No episodes of AR or development of dnDSA were observed during follow-up. Conclusions: GLP1-RA in KT patients can be a safe and effective option for the management of DM in KT. Resumen: Introducción: En los pacientes receptores de trasplante renal (TR) la diabetes mellitus (DM) se relaciona con una mayor mortalidad y menor supervivencia del injerto. Los agonistas del receptor del péptido 1 similar al glucagón (ar-GLP1) han demostrado beneficios cardiovasculares y renales en la población general. Sin embargo, su evidencia en pacientes TR es limitada. Objetivo: Analizar la eficacia y seguridad de los ar-GLP1 en una cohorte de pacientes TR. Métodos: Estudio de cohortes retrospectivo multicéntrico de los pacientes TR con DM que iniciaron ar-GLP1 de administración subcutánea en 3 hospitales de la provincia de Cádiz entre febrero de 2016 y julio de 2022. Se recogió filtrado glomerular estimado (FGe), proteinuria y peso al inicio del tratamiento y tras 6 y 12 meses. Analizamos control glucémico, tensión arterial, perfil lipídico y niveles valle y dosis de tacrolimus. Documentamos episodios de rechazo agudo (RA), anticuerpos donantes específicos de novo (DSAn) y efectos adversos. Resultados: En este periodo 96 TR con DM iniciaron tratamiento con ar-GLP1, de los cuales 84 cumplieron el seguimiento mínimo de 6 meses y 61 pacientes de 1 año. Se observó una reducción significativa de la proteinuria (−19.1 mg/g, p = 0.000; −46.6 mg/g, p = 0.000), peso (−3.6 kg, p = 0.000; −3.6 kg, p = 0.000), hemoglobina glicosilada (−0.7 %, p = 0.000; −0.9%, p = 0.000), tensión arterial sistólica (−7.5 mmHg, p = 0.013; −7.3 mmHg, p = 0.004), colesterol total (−11.5 mg/dL, p = 0.001; −15.6 mg/dl, p = 0.002) y LDL colesterol (− 9.2 mg/dl, p = 0.002; −16.8 mg/dl, p = 0.000) a los 6 meses y al año de seguimiento. El FGe se mantuvo estable y no se modificó ni la dosis ni los niveles valle de tacrolimus. No se objetivaron episodios de RA ni desarrollo de DSAn durante el seguimiento. Conclusiones: Los ar-GLP1 en pacientes TR demuestran que puede ser una opción segura y eficaz para el manejo de la DM en TR. |
| format | Article |
| id | doaj-art-ecc65c5d41034a27b442725694b6450e |
| institution | OA Journals |
| issn | 2013-2514 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Nefrología (English Edition) |
| spelling | doaj-art-ecc65c5d41034a27b442725694b6450e2025-08-20T01:58:08ZengElsevierNefrología (English Edition)2013-25142024-11-0144688589310.1016/j.nefroe.2024.11.007Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipientsLuis Alberto Vigara0Florentino Villanego1Cristhian Orellana2Myriam Eady3María Gabriela Sánchez4Marta Alonso5María Belén García6José Manuel Amaro7Teresa García8Auxiliadora Mazuecos9Department of Nephrology, Puerta del Mar University Hospital, Cádiz, Spain; Department of Nephrology, Jerez de la Frontera University Hospital, Cádiz, Spain; Corresponding author.Department of Nephrology, Puerta del Mar University Hospital, Cádiz, SpainDepartment of Nephrology, Puerta del Mar University Hospital, Cádiz, SpainDepartment of Nephrology, Jerez de la Frontera University Hospital, Cádiz, SpainDepartment of Nephrology, Puerto Real University Hospital, Cádiz, SpainDepartment of Nephrology, Puerta del Mar University Hospital, Cádiz, SpainDepartment of Nephrology, Jerez de la Frontera University Hospital, Cádiz, SpainDepartment of Nephrology, Puerta del Mar University Hospital, Cádiz, SpainDepartment of Nephrology, Puerta del Mar University Hospital, Cádiz, SpainDepartment of Nephrology, Puerta del Mar University Hospital, Cádiz, SpainIntroduction: In kidney transplant (KT) recipients diabetes mellitus (DM) are associated with an increased mortality and a poorer graft survival. Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in the general population. However, there is lacking evidence in KT recipients. Objective: To analyze the efficacy and safety of glucagon-like peptide 1 receptor GLP1-RA in a cohort of KT recipients. Methods: Multicenter retrospective cohort study of KT patients with DM who started subcutaneous GLP1-RA in 3 hospitals in the province of Cádiz between February 2016 and July 2022. Estimated glomerular filtration rate (eGFR), proteinuria, and weight at baseline and after 6 and 12 months were collected. We analyzed glycemic control, blood pressure, lipid profile, and doses and trough levels of tacrolimus. We document episodes of acute rejection (AR), de novo donor-specific antibodies (dnDSA), and adverse effects. Results: During this period, 96 KT with DM started treatment with GLP1-RA, of which 84 had a minimum follow-up of 6 months and 61 were followed for 12 months. A significant reduction was observed in proteinuria (−19.1 mg/g, p = 0.000; −46.6 mg/g, p = 0.000), weight (−3.6 kg, p = 0.000; −3.6 kg, p = 0.000), glycosylated hemoglobin (−0.7%, p = 0.000; −0.9%, p = 0.000), systolic blood pressure (−7.5 mmHg, p = 0.013; −7.3 mmHg, p = 0.004), total cholesterol (−11.5 mg/dL, p = 0.001; −15.6 mg/dl, p = 0.002) and LDL cholesterol (−9.2 mg/dl, p = 0.002; −16.8 mg/dl, p = 0.000) at 6 months and 1 year of follow-up. The eGFR remained stable and the dose and trough levels of tacrolimus did not change. No episodes of AR or development of dnDSA were observed during follow-up. Conclusions: GLP1-RA in KT patients can be a safe and effective option for the management of DM in KT. Resumen: Introducción: En los pacientes receptores de trasplante renal (TR) la diabetes mellitus (DM) se relaciona con una mayor mortalidad y menor supervivencia del injerto. Los agonistas del receptor del péptido 1 similar al glucagón (ar-GLP1) han demostrado beneficios cardiovasculares y renales en la población general. Sin embargo, su evidencia en pacientes TR es limitada. Objetivo: Analizar la eficacia y seguridad de los ar-GLP1 en una cohorte de pacientes TR. Métodos: Estudio de cohortes retrospectivo multicéntrico de los pacientes TR con DM que iniciaron ar-GLP1 de administración subcutánea en 3 hospitales de la provincia de Cádiz entre febrero de 2016 y julio de 2022. Se recogió filtrado glomerular estimado (FGe), proteinuria y peso al inicio del tratamiento y tras 6 y 12 meses. Analizamos control glucémico, tensión arterial, perfil lipídico y niveles valle y dosis de tacrolimus. Documentamos episodios de rechazo agudo (RA), anticuerpos donantes específicos de novo (DSAn) y efectos adversos. Resultados: En este periodo 96 TR con DM iniciaron tratamiento con ar-GLP1, de los cuales 84 cumplieron el seguimiento mínimo de 6 meses y 61 pacientes de 1 año. Se observó una reducción significativa de la proteinuria (−19.1 mg/g, p = 0.000; −46.6 mg/g, p = 0.000), peso (−3.6 kg, p = 0.000; −3.6 kg, p = 0.000), hemoglobina glicosilada (−0.7 %, p = 0.000; −0.9%, p = 0.000), tensión arterial sistólica (−7.5 mmHg, p = 0.013; −7.3 mmHg, p = 0.004), colesterol total (−11.5 mg/dL, p = 0.001; −15.6 mg/dl, p = 0.002) y LDL colesterol (− 9.2 mg/dl, p = 0.002; −16.8 mg/dl, p = 0.000) a los 6 meses y al año de seguimiento. El FGe se mantuvo estable y no se modificó ni la dosis ni los niveles valle de tacrolimus. No se objetivaron episodios de RA ni desarrollo de DSAn durante el seguimiento. Conclusiones: Los ar-GLP1 en pacientes TR demuestran que puede ser una opción segura y eficaz para el manejo de la DM en TR.http://www.sciencedirect.com/science/article/pii/S2013251424002062Trasplante renalDiabetes mellitusAgonistas del receptor del péptido 1 similar al glucagónObesidadRiesgo cardiovascularInmunosupresión |
| spellingShingle | Luis Alberto Vigara Florentino Villanego Cristhian Orellana Myriam Eady María Gabriela Sánchez Marta Alonso María Belén García José Manuel Amaro Teresa García Auxiliadora Mazuecos Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipients Nefrología (English Edition) Trasplante renal Diabetes mellitus Agonistas del receptor del péptido 1 similar al glucagón Obesidad Riesgo cardiovascular Inmunosupresión |
| title | Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipients |
| title_full | Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipients |
| title_fullStr | Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipients |
| title_full_unstemmed | Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipients |
| title_short | Use of glucagon-like peptide type 1 receptor agonists in kidney transplant recipients |
| title_sort | use of glucagon like peptide type 1 receptor agonists in kidney transplant recipients |
| topic | Trasplante renal Diabetes mellitus Agonistas del receptor del péptido 1 similar al glucagón Obesidad Riesgo cardiovascular Inmunosupresión |
| url | http://www.sciencedirect.com/science/article/pii/S2013251424002062 |
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