In a study of 18,042 patients, GLP-1 receptor agonists were associated with a lower rate of compared to placebo.
Treatment with GLP-1 receptor agonists resulted in a risk ratio of 0.82 for major adverse kidney events, indicating a significant reduction.
A slightly lower incidence of all-cause mortality was observed, with a hazard ratio of 0.84, although this finding has moderate certainty.
The protective effect on kidney events was consistent in patients with stage 3b , showing a risk ratio of 0.78.
No significant differences were found in major adverse cardiovascular events or cardiovascular mortality, which may be due to insufficient statistical power.
Simplified
INTRODUCTION: The effects of glucagon-like peptide 1 receptor agonists (GLP-1 RA) in patients with diabetes and established (CKD) remain unclear.
METHODS: We systematically searched PubMed, Embase, and Cochrane Library from inception to May 2024 for randomized controlled trials (RCTs) and respective post hoc studies comparing GLP-1 RAs versus placebo in patients with type 2 diabetes mellitus (T2DM) and established CKD (as per study definition or otherwise defined as having an estimated glomerular filtration rate less than 60 mL/min/1.73 m2 and/or urine albumin-to-creatinine ratio more than 30 mg/g). We applied a random-effects model to pool risk ratios (RRs), hazard ratios (HRs), and 95% confidence intervals (CIs).
RESULTS: We included 10 RCTs and post hoc analyses comprising 18,042 patients, of whom 9,164 (50.8%) were treated with GLP-1 RAs. There were significantly lower rates of (RR 0.82; 95% CI: 0.74-0.90; p < 0.001; high certainty) and a slightly lower incidence of all-cause mortality (HR 0.84; 95% CI: 0.71-1.00; p = 0.046; moderate certainty) with the use of GLP-1 RAs relative to placebo. This kidney protection remained consistent in patients with stage 3b CKD (RR 0.78; 95% CI: 0.65-0.94; p = 0.009; high certainty). No significant differences were observed in major adverse cardiovascular events (HR 0.89; 95% CI: 0.78-1.02; p = 0.090; low certainty) or cardiovascular mortality (HR 0.80; 95% CI: 0.60-1.09; p = 0.155; very low certainty), possibly due to a lack of statistical power.
CONCLUSION: GLP-1 RAs were tied to a lower incidence of all-cause mortality and major adverse kidney events in patients with T2DM and established CKD.
Key numbers
0.82
Reduction in
Risk ratio for with GLP-1 RAs vs. placebo.
0.84
Lower All-Cause Mortality Rate
for all-cause mortality with GLP-1 RAs vs. placebo.
18,042
Sample Size
Total number of patients included in the meta-analysis.
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All authors report no relationships that could be construed as a conflict of interest. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
