胰高血糖素样肽1受体激动剂在肾移植患者中的应用

IF 2 4区医学 Q2 UROLOGY & NEPHROLOGY

Nefrologia Pub Date : 2024-11-01 DOI:10.1016/j.nefro.2023.06.010

Luis Alberto Vigara , Florentino Villanego , Cristhian Orellana , Myriam Eady , María Gabriela Sánchez , Marta Alonso , María Belén García , José Manuel Amaro , Teresa García , Auxiliadora Mazuecos

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引用次数: 0

摘要

导言在肾移植（KT）受者中，糖尿病（DM）与死亡率增加和移植物存活率降低有关。胰高血糖素样肽 1 受体激动剂（GLP1-RA）已在普通人群中证实对心血管和肾脏有益。方法对 2016 年 2 月至 2022 年 7 月期间在加的斯省三家医院开始皮下注射 GLP1-RA 的 KT 患者进行多中心回顾性队列研究。我们收集了基线时以及6个月和12个月后的估计肾小球滤过率（eGFR）、蛋白尿和体重。我们分析了血糖控制、血压、血脂、他克莫司的剂量和谷值水平。我们记录了急性排斥反应（AR）、新供体特异性抗体（dnDSA）和不良反应的发生情况。结果在此期间，96 名患有 DM 的 KT 开始接受 GLP1-RA 治疗，其中 84 人接受了至少 6 个月的随访，61 人接受了 12 个月的随访。蛋白尿（-19.1 mg/g，P = .000；-46.6 mg/g，P = .000）、体重（-3.6 kg，P = .000；-3.6 kg，P = .000）、糖化血红蛋白（-0.7%，P = .000；-0.9%，P = .000）、收缩压（-7.5毫米汞柱，P = .013；-7.3毫米汞柱，P = .004）、总胆固醇（-11.5毫克/分升，P = .001；-15.6毫克/分升，P = .002）和低密度脂蛋白胆固醇（-9.2毫克/分升，P = .002；-16.8毫克/分升，P = .000）。eGFR 保持稳定，他克莫司的剂量和谷值水平没有变化。结论 GLP1-RA 在 KT 患者中的应用是治疗 KT DM 的一种安全有效的选择。

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Uso de los agonistas del receptor del péptido similar al glucagón tipo 1 en pacientes trasplantados renales

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 three 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 = .000; −46.6 mg/g, P = .000), weight (−3.6 kg, P = .000; −3.6 kg, P = .000), glycosylated hemoglobin (−0.7%, P = .000; −0.9%, P = .000), systolic blood pressure (−7.5 mmHg, P = .013; −7.3 mmHg, P = .004), total cholesterol (−11.5 mg/dl, P = .001; −15.6 mg/dl, P = .002) and LDL cholesterol (−9.2 mg/dl, P = .002; −16.8 mg/dl, P = .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.

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来源期刊

Nefrologia 医学-泌尿学与肾脏学

CiteScore

3.40

自引率

7.70%

发文量

148

审稿时长

47 days

期刊介绍： Nefrología is the official publication of the Spanish Society of Nephrology. The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages.