SUN-599 - Improving Renal Transplant Eligibility with Tirzepatide in Patients with Type 2 Diabetes, Obesity and Advanced Chronic Kidney Disease

Background:
In patients with type 2 diabetes mellitus(T2DM) and chronic kidney disease (CKD), a BMI>35kg/m2 precludes renal transplant assessment. Dialysis is associated with higher long-term costs and morbidity compared to transplantation (1). We assessed the role of tirzepatide in improving body mass index (BMI) and glycemic control to facilitate transplant assessment eligibility.

Methods:
From diabetes, dialysis and low creatinine clearance renal clinics, we identified patients with type 2 diabetes mellitus with suboptimal glycemic control, advanced chronic kidney disease on dialysis or a glomerular filtration rate (eGFR) < 18ml/min/1.73m² and BMI>35 kg/m². They were ineligible for transplant assessment due to elevated BMI and met the national criteria for tirzepatide use. Tirzepatide was initiated in these patients, with monitoring of BMI and glycated hemoglobin. Patients achieving target BMI were referred for transplant assessment.

Results:
Seventeen patients received tirzepatide for an average of ten months. Baseline mean weight was 112.7 kg, BMI 41.2 kg/m² and HbA1c 61.9 mmol/mol (7.8%). At follow-up, mean weight fell to 102.6 kg, BMI to 37.5 kg/m² and HbA1c to 52 (6.9%) mmol/mol.

Eight patients (47%) attained BMI < 35 kg/m², enabling transplant assessment. In this subgroup, mean weight decreased from 107.4kg to 96.4kg, BMI from 38.3 kg/m² to 34.1 kg/m² and HbA1c from 62.9 mmol/mol (7.9%) to 52.8 mmol/mol (7%). Tirzepatide was well tolerated in this cohort with no reported severe hypoglycaemia.

Conclusions:
Tirzepatide effectively improves glycemic control and reduces BMI in obese patients with T2DM and advanced CKD, rendering patients eligible for renal transplant assessment and potentially enhancing quality of life, survival and driving the development of a care pathway for these patients, with a potential to extend this to other specialities with obese, transplant ineligible patients with or without diabetes.

References:
(1) Survival for waitlisted kidney failure patients receiving transplantation versus remaining on waiting list: systematic review and meta-analysis. BMJ. A. Sharif. 2022;376

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