(86) Antihyperglycemic Use in Hemodialysis-Dependent Kidney Failure

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1131

Presenting Author(s)

Til Stürmer, MD, MPH, PhD, FISPE
– UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States

Co-Author(s)

Klara R. Klein
– University of North Carolina at Chapel Hill - School of Medicine, Chapel Hill, North Carolina, United States
Virginia Pate, MS
– Analyst, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
Magdalene M. Assimon, PharmD, PhD
– Research Assistant Professor, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
John Buse
– Division of Endocrinology and Metabolism, Department of Medicine, University of North Carolina at Chapel Hill, United States
Jenny Flythe
– Division of Nephrology and Hypertension, Department of Medicine, University of North Carolina at Chapel Hill, United States

Background: At least two-thirds of people with hemodialysis-dependent kidney failure have comorbid diabetes which associates with higher mortality. Some GLP-1 receptor agonists (RA) do not require renal dosing and could uniquely benefit dialysis patients, individuals with tremendous cardiovascular disease burdens.

Objectives: To describe trends of antihyperglycemic prescriptions among individuals with comorbid diabetes and dialysis-dependent kidney disease.

Methods: Using data from a national surveillance system for kidney failure in the U.S. that includes Medicare Part D prescription drug claims, we examined the quarterly prevalence of antihyperglycemic use from 2012 to 2017 among individuals with diabetes treated with hemodialysis. We determined the prevalence of antihyperglycemic prescriptions for agents approved for use in dialysis-dependent kidney disease alone and in combination with insulin. Additionally, we characterized antihyperglycemic users in October 2017.

Results: Among the 129,865 hemodialysis patients with comorbid diabetes, insulin was the most prescribed agent (33%), followed by sulfonylureas (SU, 7%), DPP4 inhibitors (DPP4i, 5%), and thiazolidinediones (1%) in October 2017. SU use fell, and DPP4i use rose from 2012 to 2017. Less than 5% of the total population received combination therapy of insulin plus a second agent. In 2013, 2.3% of the patients were prescribed insulin plus SU, and 0.9% were prescribed insulin plus DPP4i. Conversely, in 2017, insulin plus DPP4i was more commonly prescribed (insulin + DPP4i: 1.6% vs. insulin + SU: 1.4%). Disregarding kidney disease as an atherosclerotic cardiovascular disease (ASCVD) risk factor, 65% of patients met American Diabetes Association ASCVD criteria, and 96% were at high risk for ASCVD. GLP-1 RAs were prescribed to less than 1% of patients. Twenty percent of individuals prescribed GLP-1 RAs had an endocrinology claim in the prior 6 months, compared to 10% of the total population of individuals with comorbid diabetes treated with hemodialysis.

Conclusions: GLP-1 RA use by hemodialysis patients is limited. There is compelling need to establish the safety and efficacy of GLP-1 RAs in this high-risk population. Moreover, despite complex needs, patients with dialysis-dependent kidney disease and diabetes are infrequently seen by endocrinologists.