Dulaglutide may prevent diabetic kidney disease in patients with type 2 diabetes

The study, published in Diabetes Care, reported that dulaglutide improved composite renal outcomes in T2D patients with CVD (cardiovascular disease) history or risk factors. Additionally, patients treated with DU versus placebo had a smaller mean annual decline in eGFR (estimated glomerular filtration rate) slope (−1.37 versus −1.56 mL/min/1.73 m2/yr).

The REWIND (Researching Cardiovascular Events with a Weekly INcretin in Diabetes) trial showed that dulaglutide 1.5 mg was associated with improved composite renal outcomes that included new-onset microalbuminuria in type 2 diabetes patients with previous CVD or CV risk factors. The exploratory post hoc analysis by Fady T. Botros, Eli Lilly and Company, Indianapolis, IN, and colleagues evaluated kidney function–related outcomes, excluding the new-onset macroalbuminuria component among the participants of the REWIND trial.

For this purpose, the researchers performed intent-to-treat analyses on REWIND participants (n = 4,949 DU, n = 4,952 placebo). They examined the time to occurrence of a composite kidney function-related outcome.

Time to occurrence of a composite kidney function–related outcome (≥40% sustained decline in eGFR, per the Chronic Kidney Disease Epidemiology Collaboration 2009 equation, renal-related death, or end-stage renal disease), and mean annual eGFR slope. Analyses were conducted overall and within subgroups defined by baseline UACR (urinary albumin-to-creatinine ratio <30 or ≥30 mg/g) and baseline eGFR (<60 or ≥60 mL/min/1.73 m2).

The authors reported the following findings:

• The post hoc composite kidney function–related outcome occurred less frequently among participants assigned to DU than placebo (hazard ratio [HR] 0.75), with no evidence of a differential DU treatment effect by UACR or eGFR subgroup.
• A ≥40% sustained eGFR decline occurred less frequently among participants assigned to DU than placebo (HR 0.72).
• The mean annual decline in eGFR slope was significantly smaller for participants assigned to DU than placebo (−1.37 versus −1.56 mL/min/1.73 m2/year); all subgroups had similar results.

Dulaglutide was associated with a 25% reduced hazard of the composite kidney function-related outcome compared with a placebo.

"Our post hoc analyses suggest that 1.5 mg dulaglutide could provide renal benefits to adults with type 2 diabetes at risk of cardiovascular disease and with varying renal function," the authors concluded.

Reference:

Fady T. Botros, Hertzel C. Gerstein, Raleigh Malik, Claudia Nicolay, Anastasia Hoover, Ibrahim Turfanda, Helen M. Colhoun, Jonathan E. Shaw; Dulaglutide and Kidney Function–Related Outcomes in Type 2 Diabetes: A REWIND Post Hoc Analysis. Diabetes Care 2023; dc230231. https://doi.org/10.2337/dc23-0231