American Diabetes Association
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Effects of Tirzepatide Versus Insulin Glargine on Cystatin C-Based Kidney Function: A SURPASS-4 Post-Hoc Analysis

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posted on 2023-06-02, 19:10 authored by Hiddo J L Heerspink, Naveed Sattar, Imre Pavo, Axel Haupt, Kevin L Duffin, Zhengyu Yang, Russell J Wiese, Jonathan M Wilson, Andrea Hemmingway, David Z I Cherney, Katherine R Tuttle



Tirzepatide reduces HbA1c and body weight, and creatinine-based estimated glomerular filtration rate (eGFR) decline. Unlike eGFR-creatinine, eGFR-cystatin C is unaffected by muscle mass changes. We assessed effects of tirzepatide on eGFR-creatinine and -cystatin C.

Research Design and Methods

Our primary outcome was eGFR change from baseline at 52 weeks with pooled tirzepatide (5, 10, 15 mg) and titrated insulin glargine in adults with type 2 diabetes and high cardiovascular risk (SURPASS-4).


LSM (SE) eGFR-creatinine (mL/min/1.73m2) change from baseline with tirzepatide and insulin glargine was -2.5 (0.38) and -3.9 (0.38) (between-group difference 1.4 [95% CI, 0.3 to 2.4]), and was -3.5 (0.37) and -5.3 (0.37) (between-group difference 1.8 [0.8 to 2.8]) for eGFR-cystatin C. Baseline, 1-year, and 1-year change from baseline values significantly correlated between eGFR-cystatin C and -creatinine. eGFR-measure changes did not correlate with body weight changes.


Tirzepatide slows the eGFR decline rate, supporting a kidney-protective effect. 


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