Real-world trends in glucagon-like peptide-1 receptor agonists prescribing in acute kidney disease: a global federated-network study of dialysis-requiring acute kidney injury survivors

Year: 2025

Type: article

Abstract: Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) confer cardiovascular and renal benefits in type 2 diabetes mellitus (T2DM). However, their real-world utilization in acute kidney disease (AKD) remains underexplored. Methods: Using the TriNetX Global Network, we identified adults who survived dialysis-requiring acute kidney injury and met Acute Disease Quality Initiative 16 criteria for AKD (2012-2022). Prescribing trends and determinants of GLP-1 RAs were analyzed with logistic regression. Results: Among 1,095,318 post-dialysis AKD patients, 8,334 (0.8%) received GLP-1 RAs. Prescription rates reached 4.5% in patients with T2DM and rose steeply after 2018, largely driven by long-acting agents. Independent positive predictors (odds ratio [OR], 95% confidence interval [CI]) were T2DM (6.6, 6.01-7.27), chronic kidney disease (CKD) stage 3 (1.7, 1.61-1.85), obesity (1.5, 1.46-1.63), and hypertension (1.4, 1.31-1.49). Liver or cerebrovascular disease and anticoagulant use were negative predictors. Co-medication with insulin, metformin or sodium-glucose cotransporter 2 inhibitor was common. GLP-1 RA users had higher risks of hypoglycemia (5.4, 4.87-5.99), depression (2.6, 2.51-2.80), gastroparesis (2.6, 2.37-2.83) and other gastrointestinal events, but a lower risk of dementia (0.7, 0.60-0.81), with values representing OR and 95% CI, respectively. Nausea/vomiting declined over the decade, whereas constipation increased. Other adverse event rates were stable. Conclusion: Real-world use of GLP-1 RAs in AKD remains modest but is accelerating, especially in patients with T2DM, CKD stage 3 and obesity. Given the elevated rates of hypoglycemia, mood disorders and gastrointestinal intolerance, careful monitoring is warranted when prescribing these agents in the post-dialysis AKD setting.

Source: Kidney Research and Clinical Practice

DOI: 10.23876/j.krcp.25.104

Authors: Heng-Chih Pan, Chung-An Wang, Jui-Yi Chen, Kang-Yung Peng, Vin-Cent Wu

Institutions: National Taiwan University, Chang Gung University, Keelung Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taipei Medical University, Chi Mei Medical Center, Chia Nan University of Pharmacy and Science, National Taiwan University Hospital

Language: English

Topic: Diabetes Treatment and Management

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: diamond

Funders: Chang Gung Medical Foundation, Ministry of Science and Technology, Taiwan

OpenAlex ID: W4417261946