Glucagon-like peptide 1 (GLP-1) receptor agonists for people with chronic kidney disease and diabetes.
A Cochrane systematic review found that in people with chronic kidney disease and type 2 diabetes, GLP-1 receptor agonists probably reduce all-cause death and major cardiovascular events but probably have little or no effect on kidney failure.
Background
Approximately 40% of people with diabetes develop kidney failure and face accelerated cardiovascular risk. GLP-1 receptor agonists are glucose-lowering agents that also support weight control. This Cochrane review assessed their benefits and harms in people with chronic kidney disease and diabetes.
Study design
The review included 42 randomized controlled studies involving 48,148 participants, all with type 2 diabetes, searched to September 2024. CKD spanned stages 1 to 5, including one study in patients on dialysis, and the median follow-up was 26 weeks. Outcomes were compared mainly against placebo, with certainty of evidence assessed using the GRADE approach.
Key findings
Compared with placebo, GLP-1 receptor agonists probably reduced all-cause death (RR 0.85, 95% CI 0.74 to 0.98; moderate certainty) but may have little or no effect on cardiovascular death (RR 0.84, 95% CI 0.68 to 1.05; low certainty). They probably decreased 3-point major adverse cardiovascular events (RR 0.84, 95% CI 0.73 to 0.98) and 4-point MACE (RR 0.77, 95% CI 0.67 to 0.89). They probably had little or no effect on kidney failure defined as dialysis or transplant (RR 0.86, 95% CI 0.66 to 1.13) or on composite kidney outcomes (RR 0.89, 95% CI 0.78 to 1.02), and may have little or no effect on severe hypoglycemia.
Clinical implications
GLP-1 receptor agonists probably lower mortality and major cardiovascular events in people with chronic kidney disease and diabetes, with absolute benefits estimated to be larger in more advanced CKD stages. However, the evidence suggests little or no effect on hard kidney failure endpoints, and comparisons against standard care or other glucose-lowering agents remained uncertain.
Category
Research
Source
Cochrane Database Syst Rev
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