Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal AssociationSep 22, 2025

How GLP-1 receptor agonists may affect kidney health: a review and combined analysis

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jun 28, 2026

Abstract

Essence

In randomized-trial evidence, GLP-1 receptor agonists were linked to better composite renal outcomes and less renal decline, alongside cardiovascular benefit.

Evidence

This systematic review and random-effects meta-analysis pooled 19 trials with 90,882 patients and found lower risk of the primary renal outcome (RR 0.81), renal functional decline (RR 0.88), microalbuminuria (RR 0.76), major adverse cardiovascular events (RR 0.85), and all-cause mortality (RR 0.86).

Caveat

This was review-level evidence with heterogenous trials, no significant reduction in progression to kidney failure itself (RR 0.86, 95% CI 0.71-1.05), more gastrointestinal side effects, and limited direct evidence for patients without diabetes.

Simplified

BACKGROUND AND HYPOTHESIS: Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are anti-hyperglycaemic agents, with cardioprotective effects, however renal protective effects remain unclear.We aimed to assess the effects of GLP1-RAs on renal outcomes in patients with or without diabetes.

METHODS: We performed a systematic review and meta-analysis with Medline, EMBASE and the Cochrane Register searched to December 2024. The primary outcome was the composite of kidney failure (defined as eGFR < 15 mL/min/1.73m2) or dialysis requirement, worsening of renal function and changes in proteinuria. Subgroup analysis was performed based on diabetic status, CKD and individual GLP1-RA drugs. Relative risks (RR) with 95% confidence intervals (CI) for individual trials were pooled using random effects models.

RESULTS: We identified 19 trials including 90 882 patients. Mean age was 60.8 years and mean follow-up was 25.9 months. GLP1-RAs were associated with a 19% reduction in the risk of primary renal outcome (RR 0.81, 95% CI 0.73-0.89), a 12% reduction in renal functional decline (RR 0.88, 95% CI 0.81-0.95) and a 0.45 ml/min/1.73m2 reduction in yearly loss (16 trials, MD 0.45, 95% CI 0.10-0.81). GLP1-RAs also reduced microalbuminuria by 24% (RR 0.76, 95% CI 0.71-0.82), HbA1c (units: %) by 0.61 (MD -0.61, 95% CI -0.76- -0.49) and body weight by 5 kg (MD -5.24, 95% CI -7.46--3.02). Although there were no significant differences in progression to kidney failure (RR 0.86, 95% CI 0.71-1.05), GLP1-RAs reduced the incidence of major adverse cardiovascular events (MACE) by 15% (RR 0.85, 95% CI 0.81-0.90) and all-cause mortality by 14% (RR 0.86, 95% CI 0.82-0.91). No significant differences were seen in severe adverse events (RR 0.96, 95% CI 0.90-1.01). However, there were more gastroenterological side effects.

CONCLUSIONS: GLP1-RAs demonstrated cardiovascular and renal benefits. Further high-quality randomised trials assessing their effects in patients without diabetes, with or without proteinuria and/or CKD are needed.