Glucagon-like peptide-1 receptor agonists in diabetic kidney disease: A review of their kidney and heart protection.
GLP-1 receptor agonists reduce major adverse cardiovascular events by roughly 14% and a composite kidney outcome by about 21% in patients with type 2 diabetes, with kidney benefit driven largely by reductions in albuminuria.
Background
Atherosclerotic cardiovascular disease and diabetic kidney disease remain the leading causes of morbidity and mortality in type 2 diabetes, and substantial residual risk persists despite renin-angiotensin system blockade and glycemic control. GLP-1 receptor agonists, established for cardiovascular risk reduction, have increasingly been examined for kidney protection in this population.
Key recommendations
This review synthesises cardiovascular outcome trial and meta-analysis data showing that GLP-1 receptor agonists reduce 3-point major adverse cardiovascular events by about 14% and a composite kidney outcome by about 21% in type 2 diabetes, with the kidney benefit achieved largely through reduction in albuminuria. The benefits on cardiovascular events were at least as large among patients with eGFR below 60. The review highlights underutilisation of these agents and of albuminuria testing in clinical practice.
Clinical implications
Proposed mechanisms of cardiorenal protection include blood pressure lowering, weight loss, improved glucose control, reduced oxidative stress and inflammation, and natriuresis. At the time of the review it remained uncertain whether GLP-1 receptor agonists slow eGFR decline or progression to end-stage kidney disease, with dedicated kidney outcome trials such as FLOW awaited. Cardiovascular and nephrology clinicians are encouraged to identify diabetic kidney disease earlier and apply these therapies in appropriate higher-risk patients.
Category
Research
Source
Am J Prev Cardiol
More from ASNRT News
Browse the latest news, society announcements, KDIGO guideline updates, and AJNT issue releases on the ASNRT newsroom.