Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-Use of GLP-1 Receptor Agonists in Patients on Dialysis and in Kidney Transplant Recipients

Use of GLP-1 Receptor Agonists in Patients on Dialysis and in Kidney Transplant Recipients

Video Transcription

Video Summary

Dr. Connie Rhee (UCLA) reviews the emerging role of GLP‑1 receptor agonists (GLP‑1 RAs) in people with end-stage kidney disease (ESKD) on dialysis and in kidney transplant recipients—groups with high burdens of diabetes, obesity, and cardiovascular risk. She notes rising obesity among incident dialysis patients and how obesity remains a major barrier to transplant listing, making weight-loss therapies clinically important. Guideline recommendations (KDIGO, ADA) support long-acting GLP‑1 RAs for patients with type 2 diabetes and CKD, prioritizing agents with proven cardiovascular benefit; some agents (e.g., liraglutide/semaglutide/dulaglutide) generally do not require dose adjustment, while exenatide/lixisenatide are avoided in advanced CKD. Evidence in dialysis is limited, but observational USRDS data associate GLP‑1 RA use with weight loss, lower mortality, and higher likelihood of waitlisting, with signals for increased diabetic retinopathy and concern about GI side effects and nutrition. In transplant recipients, observational cohorts suggest lower mortality and graft loss without major tacrolimus level changes, but possible retinopathy/pancreatitis signals. She emphasizes major real-world barriers: high costs and restricted Medicare/Medicaid access, urging more trials and equitable implementation.

Asset Subtitle

Connie Rhee

Meta Tag

Module DKD

Speaker Connie Rhee

Keywords

GLP-1 receptor agonists

end-stage kidney disease dialysis

kidney transplant recipients

obesity and transplant waitlisting

type 2 diabetes chronic kidney disease guidelines

cardiovascular outcomes and mortality