Pladevall-Vila M, Ziemiecki R, Johannes CB, Khan AM, Mines D, Ebert N, Kovesdy CP, Thomsen RW, Baak BN, Garcia-Sempere A, Kanegae H, Coleman CI, Walsh M, Andersen IT, Bernal CR, Cabaninas CR, Christiansen CF, Farjat AE, Gay A, Gee P, Herings RMC, Hurtado I, Kashihara N, Kristensen FPB, Liu F, Okami S, Overbeek JA, Beest FJAP, Yamashita S, Yano Y, Layton JB, Vizcaya D, Oberprieler NG. Clinical profile and treatment patterns in individuals with type 2 diabetes and chronic kidney disease who initiate a GLP-1 receptor agonist: a multinational cohort study. Diabetes Ther. 2025 Mar 19. doi: 10.1007/s13300-025-01717-8

INTRODUCTION: Novel therapies are emerging for the prevention of chronic kidney disease (CKD) progression in patients with type 2 diabetes (T2D). Within the FOUNTAIN platform (NCT05526157; EUPAS48148), this real-world study aimed to characterize cohorts of adults with CKD and T2D starting therapy with a glucagon-like peptide-1 receptor agonist (GLP-1 RA) in Europe, Japan, and the United States (US) during 2012-2021.

METHODS: This multinational, multicohort study was conducted in 5 data sources: the Danish National Health Registers (DNHR) (Denmark), PHARMO Data Network (PHARMO) (Netherlands), Valencia Health System Integrated Database (VID) (Spain), Japan Chronic Kidney Disease Database Extension (J-CKD-DB-Ex) (Japan), and Optum’s de-identified Clinformatics® Data Mart Database (CDM) (US). Eligible patients had T2D (defined by data source–specific algorithms) and CKD (based on diagnosis codes, estimated glomerular filtration rate values, and/or urine albumin-to-creatinine ratio) and initiated an GLP-1 RA during 2012-2021. Baseline demographic, lifestyle, and clinical characteristics were analyzed, and treatment patterns were described.

RESULTS: Study cohorts included 18,929 GLP-1 RA initiators in DNHR; 476 in PHARMO; 11,798 in VID; 329 in J-CKD-DB-Ex; and 70,158 in CDM. Across cohorts, mean age ranged from 66.1 years in J-CKD-DB-Ex to 67.9 years in CDM, and between 46.6% (PHARMO) and 59.6% (J-CKD-DB-Ex) of patients were men. There was a steady increase in GLP-1 RA initiators from 2012 (when 1.6%-4.8% of GLP-1 RA initiators started therapy) to 2019 (when 19.8%-31.5% started therapy). The median duration of initial treatment with a GLP-1 RA ranged from 2.3 months (PHARMO) to 12.4 months (VID). At 1-year follow-up, between 52% (CDM) and 78% (DNHR) of patients were receiving treatment. Findings suggested that GLP-1 RA use was independent of CKD severity.

CONCLUSIONS: During 2012-2021, GLP-1 RA use steadily increased across multinational cohorts of patients with T2D and CKD, and persistence with treatment was high. GLP-1 use was independent of CKD severity.