GLP-1 receptor agonists (GLP-1RAs) may effectively reduce hyperglycemia in patients with mild or moderately impaired kidney function.
Glycemic control with GLP-1RAs was not markedly less effective in patients with mild or moderate renal impairment compared to those with normal kidney function.
GLP-1RAs are associated with improvements in cardiorenal risk factors, such as systolic blood pressure and body weight.
Several large cardiovascular outcome studies indicated reduced risks of composite renal outcomes, primarily due to a decrease in macroalbuminuria.
Limited studies suggest potential renoprotective effects of GLP-1RAs that warrant further investigation.
Simplified
Type 2 diabetes mellitus (T2DM) is the most common cause of (CKD), and when it causes CKD it is collectively referred to as . One of the newer therapies for managing hyperglycemia is the glucagon-like peptide-1 receptor agonist (GLP-1RA) drug class. This review summarizes the effects of GLP-1RAs in patients with T2DM with CKD and evidence for renoprotection with GLP-1RAs using data from observational studies, prospective clinical trials, post hoc analyses, and meta-analyses. Evidence from some preclinical studies was also reviewed. Taken together, subgroup analyses of patients with varying degrees of renal function demonstrated that glycemic control with GLP-1RAs was not markedly less effective in patients with mild or moderate renal impairment vs that in patients with normal function. GLP-1RAs were associated with improvements in some cardiorenal risk factors, including systolic blood pressure and body weight. Furthermore, several large cardiovascular outcome studies showed reduced risks of composite renal outcomes, mostly driven by a reduction in macroalbuminuria, suggesting potential renoprotective effects of GLP-1RAs. In conclusion, GLP-1RAs effectively reduced hyperglycemia in patients with mild or moderately impaired kidney function in the limited number of studies to date. GLP-1RAs may be considered in combination with other glucose-lowering medications because of their ability to lower glucose in a glucose-dependent manner, lowering their risk for hypoglycemia, while improving some cardiorenal risk factors. Potential renoprotective effects of GLP-1RAs, and their renal mechanisms of action, warrant further investigation.
Key numbers
−1.4%
HbA1c Reduction with Exenatide
Reduction in HbA1c for eGFR 30-59 mL/min/1.73 m
−39.6 mg/g
Albuminuria Reduction with GLP-1RAs
Mean decrease in albuminuria in GLP-1RA-treated patients
5.8%
Composite Renal Outcome Reduction
Incidence of composite renal outcome with exenatide vs placebo
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