The Effects of GLP-1RA-Based and SGLT2 Inhibitor Therapy on Perirenal Adipose Tissue in CKD Patients

AIMS: Perirenal adipose tissue (PRAT) surrounds the kidney and may contribute to chronic kidney disease (CKD) progression. SGLT2 inhibitors have been associated with reductions in this depot, but PRAT has not been quantified under GLP-1RA-based therapy in CKD. We assessed ultrasound-measured PRAT thickness under both treatments and whether changes tracked weight loss. MATERIALS AND METHODS: Adults with CKD Stages 1-4 in the prospective ADIPO-CKD inception cohort underwent ultrasound at baseline and at the 8-month visit. PRAT thickness was the mean of right and left measurements; epicardial adipose tissue and body composition were also assessed. Patients received neither drug class (reference), SGLT2i or GLP-1RA-based therapy. Follow-up PRAT was analysed by covariance analysis adjusted for baseline. RESULTS: Of 277 patients, 80 had paired studies (32 reference, 24 SGLT2i, 24 GLP-1RA-based; body weight 46-122 kg). PRAT was unchanged in the reference group (+0.035 cm, p = 0.376) and decreased with SGLT2i (-0.273 cm, -20.4%, p = 0.0006) and GLP-1RA-based therapy (-0.463 cm, -36.2%, p < 0.0001). Adjusted differences versus reference were -0.227 cm (95% CI -0.417 to -0.036) and -0.433 cm (-0.622 to -0.244); under multiple imputations, -0.218 cm (-0.482 to +0.046) and -0.421 cm (-0.693 to -0.149). GLP-1RA-based therapy reduced body weight, fat mass and visceral fat area; SGLT2i only body weight, modestly. PRAT change correlated with none. CONCLUSIONS: In CKD, both drug classes were associated with lower follow-up PRAT, not explained by measured body-composition change. Under multiple imputations, both estimates were essentially unchanged, though the SGLT2i interval included no difference. PRAT may represent a candidate depot-specific target. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT07309094 (ADIPO-CKD).