Semaglutide in type 2 diabetes with chronic kidney disease at high risk progression—real-world clinical practice

Abstract

Background Semaglutide (glucagon-like peptide-1 receptor-agonist, GLP-1RA) has shown nephroprotective effects in previous cardiovascular studies. However its efficacy and safety in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D) has been scarcely studied. Materials and methods this is a multicenter, retrospective, observational study in patients with T2D and CKD with A1c glycosylated haemoglobin (HbA1c) between 7.5-9.5% treated with subcutaneous semaglutide for 12 months in real-world clinical practice. Main objectives were glycemic control as HbA1c<7% and weight loss of >5%. Results 122 patients, age 65.50±11years, 62% men. Duration of T2D: 12 years and baseline HbA1c: 7.57%±1.36%, eGFR: 50.32±19.21 ml/min/1.73m2; 54% had albumin-to-creatinine ratio (UACR):30-300 mg/g and 20% UACR >300 mg/g. After 12 months of follow up: HbA1c declined -0.73%±1.09%(p<0.001) with 57% of patients achieving values <7%; weight loss -6.95 kg(p<0.001) with 59% of patients showing reduction>5% of their body weight. Systolic and diastolic blood pressure decreased -9.85 mmHg and -5.92 mmHg, respectively(p<0.001). The mean UACR reduced 51% in the group with baseline macroalbuminuria (UACR)>300 mg/g. Mean eGFR (by CKD-EPI) remained stable. The needs of basal insulin decreased 20% (p<0.005). Only 7% of patients on insulin had mild hypoglycemic episodes. Semaglutide was stopped in 5.7% of patients for digestive intolerance. Conclusions In this real-world study, patients with T2D and CKD treated with subcutaneous semaglutide for 12 months significantly improved glycemic control and decreased weight. Albuminuria decreased by >50% in patients with macroalbuminuria. The administration of GLP-1RA in patients with T2D and CKD was safe and well tolerated.

Efficacy and Safety of Semaglutide, a Glucagon-Like Peptide-1 Receptor Agonist in Real-Life: A Case Series of Patients in Maintenance Incremental Hemodialysis

“…To our best knowledge, this is the first case series in iHD and only one case report from our group, on the use of semaglutide with this hemodialysis regimen, can be found in the literature [17]. Recently, Aviles et al [18] performed a multicenter, retrospective, observational study in patients with T2DM and CKD with an eGFR using CKD-EPI formula of >15 mL/min/1.73 m 2 and HbA1c between 7.5 and 9.5% treated with SC semaglutide for 12 months in real-world clinical practice. The main objectives were glycemic control as HbA1c < 7% and weight loss of >5%.…”

Semaglutida en enfermedad renal diabética: Experiencia en dos programas de salud renal en Colombia

“…El presente estudio evaluó de forma retrospectiva los resultados obtenidos con el uso de semaglutida en pacientes con ERD, siendo uno de los pocos estudios realizados en la práctica clínica de la vida real en Colombia y en la región, encontrándose que el uso de este fármaco en pacientes con DM2 de más de 10 años de evolución y que cursen con ERD es seguro y eficaz en términos de desenlace cardiovascular, reflejando lo que se ha documentado en la literatura universal con el uso de los aR GLP-1 (15). Al momento de la realización de este manuscrito, se documentó en la literatura un estudio observacional realizado en España con características similares al nuestro, donde se realizó un seguimiento de 122 pacientes en tratamiento con semaglutida subcutáneo de forma semanal durante 12 meses; los resultados fueron similares a nuestra población, con una disminucion estadísticamente significativa de los niveles de hemoglobina glucosilada y de albuminuria en estadio A3, lo que concuerda con nuestros resultados, sin embargo, en este estudio lograron demostrar un impacto significativo en la pérdida de peso y en los niveles de tensión arterial; esta diferencia en los resultados puede ser explicada debido al tiempo de seguimiento de los pacientes, con una mayor duración del tratamiento con este aR GLP-1 y permitiendo un mayor impacto a largo plazo sobre el peso corporal (16).…”

Dual GLP-1/GIP Agonist Tirzepatide for Diabetes and Obesity: A Review of the Evidence

“…39 In comparison, patients who have been treated with semaglutide with graduated dose increments experienced reductions in systolic and diastolic BP readings by 9.85 and 5.92 mm Hg, respectively. 40 This data has been represented from separate studies, not reported by a direct comparative study between tirzepatide and semaglutide.…”