The renoprotective effect of once‐weekly GLP‐1 receptor agonist dulaglutide on progression of nephropathy in Japanese patients with type 2 diabetes and moderate to severe chronic kidney disease (JDDM67)

ABSTRACT Aims/Introduction Few studies have investigated the renoprotective effect of glucagon‐like peptide‐1 (GLP‐1) receptor in patients with chronic kidney disease (CKD). This study evaluated the effect of dulaglutide 0.75 mg on renal function in Japanese patients with type 2 diabetes and CKD stage 3 to 4. Materials and Methods Dulaglutide (group A) and non‐dulaglutide (group B) were compared using data collected from a computerized diabetes care database. For group B, propensity score weighting based on propensity scores was performed. Evaluation items were a change from baseline in hemoglobin A1c (HbA1c), body weight, urine albumin‐to‐creatinine ratio (UACR), and estimated glomerular filtration rate (eGFR), for 3 years. Results In total, the data obtained from 255 patients (125 and 130 patients for group A and B, respectively) were analyzed. Propensity score‐adjusted patient background characteristics (group A vs B) were age 70.8 vs 69.4 years, body weight 70.2 vs 72.9 kg, body mass index 27.3 vs 28.1 kg/m2, HbA1c 8.4 vs 8.5%, eGFR 47.9 vs 47.7 mL/min/1.73 m2, and UACR 218 vs 251 mg/gCr. Although there were no statistically significant differences in the change from baseline between groups A and B at most time points in eGFR, a statistically significant eGFR decline in group B was observed in slope analysis for 3 years. This renoprotective effect was marked in patients with macro‐albuminuria and/or concomitant SGLT2 inhibitor use. Conclusions Dulaglutide slowed the eGFR decline in patients with type 2 diabetes and CKD stage 3 to 4.