MO634SEMAGLUTIDE IN REAL LIFE PRACTICE DECREASES ALBUMINURIA IN HIGH RISK PROGRESSION CHRONIC KIDNEY DIABETIC PATIENTS

Abstract

Abstract Background and Aims Semaglutide has shown safety and efficacy in type 2 diabetic patients (DM2) in extensive clinical studies including patients until eGFR>15ml/min/1.73m2. Our aims are to analyse the changes in metabolic and renal parameters in chronic diabetic patients after 12 months of treatment in real life practice with semaglutide. Method Retrospective observational study. Inclusion criteria: Patients over 18 years old with DM2 and eGFR(CKD-EPI)>15 ml/min/1.73m2. We selected cases with eGFR<60 ml/min/1,73m2 and/or albuminuria/Creatinineu (albu/creatu)>30 mg/g treated with semaglutide in real life practice for 12 months. Our main objectives were to assess the changes in HbA1c and weight. Secondary objetives to analyse evolution of albuminuria (albu/creatu), eGFR(CKD-EPI), blood pressure (BP), lipidic profile and adverse events. Statistics anlysis: we used descriptive, student's t, McNemar (paired data), method by steps forward; SPSS v 19.0. Results We included 122 patients, 62% males, mean age 51,43 ± 33 years, time of DM2 12.3 ± 3.4 years, body mass index (BMI) 35.8 ± 4.79, 25% had retinopathy, 93.4% hypercholesterolemia and 97% were hypertensive, 18% were active smokers. Mean Albu/Creatu: 349.49 ± 863.16 mg/g and mean eGFR (CKD-EPI): 50.32 ± 31.47 ml/min/1.73m2. Previous cardiovascular events: 36.5% myocardial infarction, 41% congestive hearth failure, 10% peripheric arteriopathy and 6% strokes. 42.6% were already on iSGT2 who were kept and 64.8% were switched from other GLP-1ar. After 12 months of treatment with semaglitude HbA1c reduced -0.74 ± 0.41% obtaining a mean objective <7% (from 7.57±1.36 to 6.83±0.85, p<0.0001). Patients decreased weight in -6.95 ± 6.0 Kg (from 98.48±16.6 to 91.53±16.42 p<00001) more than -5% of total body weight in 69% of cases. Albuminuria reduced in -162,21 mg/g ± 365,77 (from 349.49±863.16 to 187.287±897.39 p<0.0001, 53% reduction). eGFR(CKD-EPI) remained with a low increased of 2,2 ml/min/1.73m2. Systolic and Diastolic BP decreased -9.85 ± 13.34 mmHg (from 129.95±11,27 to 120.09±09 p < 0.0001) and -5.92 ± 7.43 mmHg (from 77.05±8.95 to 71.12±7.83 p< 0.0001) respectively. LDL-cholesterol and triglyceridemia decreased in -10.79 ± 28.21.09 mg/dl (p <0.0001) and -29,15 mg/dl ± 91,47 (p <0.0001) respectively. 5 % of patients on insulin had mild hipoglycemic episodes. Our patients needed 25% less units of rapid insulin (p<0.01). Semaglutide was stopped in 5% of cases (65% because digestive intolerance). Conclusion Chronic kidney diabetic patients with grade 3 albuminuria after 12 months of treatment in real life practice with semaglutide improved their glycemic control (mean final HbA1c <7%), with 25% less needs of rapid insulin. 69% of them decreased their total body weight in > 5%. We observed 53% reduction of albuminuria and better control of blood pressure.