Kidney medicine · 2026
Real-world Evidence for Improvements in Inflammation and Anemia Biomarkers After the Initiation of GLP-1RA in Patients Receiving Hemodialysis.
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Lama Suman, Chaudhuri Sheetal, Blankenship Derek, Ban Andrea Nandorine, Usvyat Len, Pecoits-Filho Roberto, Hippen Benjamin E
Аннотация
RATIONALE & OBJECTIVE: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly used for diabetes and obesity but have not been studied in patients with kidney failure with replacement therapy receiving hemodialysis in prospective trials. GLP-1RAs may influence inflammatory pathways relevant to anemia, although their effects in hemodialysis patients remain unclear.
STUDY DESIGN: Retrospective matched cohort study.
SETTING & PARTICIPANTS: Data were derived from a large US dialysis provider (Fresenius Kidney Care). We identified 2,468 adult patients who initiated GLP-1RA therapy between January 1, 2023, and November 1, 2024, and matched 1:1 to nonusers using propensity scores based on demographic characteristics, comorbidities, and baseline laboratory values.
EXPOSURE: Initiation of GLP-1RA therapy.
OUTCOMES: Longitudinal changes over 12 months in inflammatory markers (neutrophil-to-lymphocyte ratio, white blood cell count, and albumin level) and anemia parameters (hemoglobin level, ferritin level, transferrin saturation value, erythropoiesis-stimulating agent (ESA) dose, and erythropoietin resistance index).
ANALYTICAL APPROACH: Linear mixed models were used to compare longitudinal trajectories between matched groups.
RESULTS: Compared with matched controls, GLP-1RA users demonstrated reductions in systemic inflammation, characterized by lower neutrophil-to-lymphocyte ratio (3.97 vs 4.64, with a mean difference of -0.67 [95% CI, -0.89 to -0.45]) and white blood cell counts at 12 months, alongside greater improvements in serum albumin level (3.92 vs 3.86 g/dL, with a mean difference of 0.06 [95% CI, 0.04-0.08]). Although hemoglobin levels remained comparable between groups (10.9 vs 10.84 g/dL, with a mean difference of 0.06 [95% CI, -0.004 to 0.12]), GLP-1RA users had lower cumulative ESA exposure (1,881.9 vs 2,005.8 μg; mean difference of -123.9 μg, [95% CI, -201.7 to -46.1] μg) and a modestly reduced rate of erythropoietin resistance index compared with nonusers. Additionally, iron stores (ferritin level and transferrin saturation value) were consistently higher in the GLP-1RA group.
CONCLUSIONS: In patients receiving maintenance hemodialysis, GLP-1RA agonist use was associated with reductions in inflammatory markers and lower ESA requirements; however, as an observational study, causality cannot be inferred. These findings suggest GLP-1RAs may have potential benefits in managing inflammation and inflammation-mediated anemia in kidney failure.
STUDY DESIGN: Retrospective matched cohort study.
SETTING & PARTICIPANTS: Data were derived from a large US dialysis provider (Fresenius Kidney Care). We identified 2,468 adult patients who initiated GLP-1RA therapy between January 1, 2023, and November 1, 2024, and matched 1:1 to nonusers using propensity scores based on demographic characteristics, comorbidities, and baseline laboratory values.
EXPOSURE: Initiation of GLP-1RA therapy.
OUTCOMES: Longitudinal changes over 12 months in inflammatory markers (neutrophil-to-lymphocyte ratio, white blood cell count, and albumin level) and anemia parameters (hemoglobin level, ferritin level, transferrin saturation value, erythropoiesis-stimulating agent (ESA) dose, and erythropoietin resistance index).
ANALYTICAL APPROACH: Linear mixed models were used to compare longitudinal trajectories between matched groups.
RESULTS: Compared with matched controls, GLP-1RA users demonstrated reductions in systemic inflammation, characterized by lower neutrophil-to-lymphocyte ratio (3.97 vs 4.64, with a mean difference of -0.67 [95% CI, -0.89 to -0.45]) and white blood cell counts at 12 months, alongside greater improvements in serum albumin level (3.92 vs 3.86 g/dL, with a mean difference of 0.06 [95% CI, 0.04-0.08]). Although hemoglobin levels remained comparable between groups (10.9 vs 10.84 g/dL, with a mean difference of 0.06 [95% CI, -0.004 to 0.12]), GLP-1RA users had lower cumulative ESA exposure (1,881.9 vs 2,005.8 μg; mean difference of -123.9 μg, [95% CI, -201.7 to -46.1] μg) and a modestly reduced rate of erythropoietin resistance index compared with nonusers. Additionally, iron stores (ferritin level and transferrin saturation value) were consistently higher in the GLP-1RA group.
CONCLUSIONS: In patients receiving maintenance hemodialysis, GLP-1RA agonist use was associated with reductions in inflammatory markers and lower ESA requirements; however, as an observational study, causality cannot be inferred. These findings suggest GLP-1RAs may have potential benefits in managing inflammation and inflammation-mediated anemia in kidney failure.