Real-world trends in glucagon-like peptide-1 receptor agonists prescribing in acute kidney disease: a global federated-network study of dialysis-requiring acute kidney injury survivors

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) confer cardiovascular and renal benefits in type 2 diabetes mellitus (T2DM).However, their real-world utilization in acute kidney disease (AKD) remains underexplored.Methods: Using the TriNetX Global Network, we identified adults who survived dialysis-requiring acute kidney injury and met Acute Disease Quality Initiative 16 criteria for AKD (2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019)(2020)(2021)(2022).Prescribing trends and determinants of GLP-1 RAs were analyzed with logistic regression.Results: Among 1,095,318 post-dialysis AKD patients, 8,334 (0.8%) received GLP-1 RAs.Prescription rates reached 4.5% in patients with T2DM and rose steeply after 2018, largely driven by long-acting agents.Independent positive predictors (odds ratio [OR], 95% confidence interval [CI]) were T2DM (6.6, 6.01-7.27),chronic kidney disease (CKD) stage 3 (1.7,1.61-1.85),obesity (1.5, 1.46-1.63),and hypertension (1.4,1.31-1.49).Liver or cerebrovascular disease and anticoagulant use were negative predictors.Co-medication with insulin, metformin or sodium-glucose cotransporter 2 inhibitor was common.GLP-1 RA users had higher risks of hypoglycemia (5.4,4.87-5.99),depression (2.6, 2.51-2.80),gastroparesis (2.6, 2.37-2.83)and other gastrointestinal events, but a lower risk of dementia (0.7, 0.60-0.81),with values representing OR and 95% CI, respectively.Nausea/vomiting declined over the decade, whereas constipation increased.Other adverse event rates were stable.Conclusion: Real-world use of GLP-1 RAs in AKD remains modest but is accelerating, especially in patients with T2DM, CKD stage 3 and obesity.Given the elevated rates of hypoglycemia, mood disorders and gastrointestinal intolerance, careful monitoring is warranted when prescribing these agents in the post-dialysis AKD setting.