Normal Protein Catabolic Rate (nPCR) as a Predictor of Weight Loss in Hemodialysis Patients Treated with Tirzepatide

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Normal Protein Catabolic Rate (nPCR) as a Predictor of Weight Loss in Hemodialysis Patients Treated with Tirzepatide

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Co-author 1

Jyunichiro Hashiguchi hashiguchi1215@gmail.com Nagasaki Kidney Center Department of Blood Purification Nagasaki Japan *

Co-author 2

Kenji Sawase sawakenurouro@yahoo.so.jp Nagasaki Kidney Center Department of Blood Purification Nagasaki Japan -

Co-author 3

Akihiro Maekawa a-maekawa@nagajin.jp Nagasaki Kidney Center Department of Blood Purification Nagasaki Japan -

Co-author 4

Koutaro Shimoyama kaisyokai20@gmail.com Jikei University School of Medicine Department of Nephrology Tokyo Japan -

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Introduction

Tirzepatide, a dual GLP-1/GIP receptor agonist, has demonstrated substantial weight-reducing effects in patients with type 2 diabetes mellitus (T2DM). However, its impact in maintenance hemodialysis (HD) patients remains under-explored, and spontaneous body-weight fluctuation is uncommon in this population. This study aimed to identify key parameters—particularly the normal protein catabolic rate (nPCR)—that can guide dry weight (DW) adjustment in HD patients receiving tirzepatide.

Methods

We enrolled 23 stable T2DM patients undergoing maintenance HD who were switched from existing GLP-1 receptor agonists to tirzepatide. The mean age was 63.8 ± 8.1 years, with 18 males and 5 females, and a mean dialysis duration of 5.6 ± 3.2 years. Over a 6-month observation period, we analyzed changes in DW, clinical symptoms, and nutritional indices, including nPCR, serum phosphorus, and potassium levels.

Results

Mean DW decreased significantly from 72.7 ± 11.8 kg to 70.3 ± 11.1 kg (mean change − 2.6 kg; − 3.9%). Considerable inter-individual variability was observed (SD 2.28; CV − 0.85). Among nutritional indices, only nPCR showed a significant correlation with weight loss (r = − 0.44, p = 0.04), suggesting that reduced dietary protein intake may underlie greater weight loss. Neither serum phosphorus nor potassium levels correlated with weight change.

Conclusion

nPCR serves as a sensitive marker for predicting weight change in HD patients treated with tirzepatide. Continuous monitoring of nPCR may enable early identification of appetite loss and facilitate safe DW adjustment, thereby preventing complications such as pulmonary congestion or pleural effusion during GLP-1/GIP therapy in the HD population.

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