The Nephroprotective Effects of Dulaglutide in Patients with Type 2 Diabetes and Chronic Kidney Disease: <i>A Multicenter Saudi Arabian Study</i>.

OBJECTIVE: This study aimed to evaluate the effectiveness and safety of dulaglutide in individuals with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM). METHODS: This retrospective cohort study included 212 patients with CKD (stages 1-4) and T2DM treated with once-weekly dulaglutide (1.5 mg) for either 12 or 24 months at three tertiary care centers in Saudi Arabia from January 2021 to December 2023. Safety was assessed based on the presence of adverse events. Efficacy was measured using the changes in estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1c), and body mass index (BMI). Changes in efficacy outcomes were assessed using paired t-tests. RESULTS: Baseline HbA1c was 9.1% (±1.8%), BMI was 33.0 (±6.4) kg/m, and eGFR was 68.2 (±28.5) mL/min/1.73 m. At 12 and 24 months, HbA1c decreased by 1.2% (95% confidence interval [CI]: 1.0-1.4, < 0.001) and BMI by 1.1 kg/m (95% CI: 0.9-1.3, < 0.001). Further, eGFR remained stable at 12 months (change: $-$0.1, 95% CI: $-$2.2 to 2.0, = 0.937) but increased by 2.8 mL/min/1.73 m (95% CI: 0.3-5.3, = 0.029) at 24 months, particularly in stage 3 CKD ( = 0.041). By multivariable regression analysis, with adjustment for concomitant medications, dulaglutide was associated with a significant increase in eGFR increase at 24 months (adjusted mean change: 2.6 mL/min/1.73 m, 95% CI: 0.2-5.0, = 0.034). Patients aged <60 years ( = 0.049) and with HbA1c of ≤9.0% ( = 0.002) demonstrated greater eGFR increases. Adverse events occurred in 31.6% of patients, mainly nausea (10.8%), vomiting (8.0%), and diarrhea (10.8%). CONCLUSION: Dulaglutide was associated with a modest increase in eGFR and improved glycemic control in patients with T2DM and CKD, particularly among younger individuals with moderate-stage CKD. The treatment demonstrated an acceptable safety profile.