The Impact of Glucagon-like Peptide-1 Receptor Agonists on Kidney Outcomes: A Meta-Analysis of Randomized Placebo-Controlled Trials

Abstract

ferent populations. Methods: We conducted a meta-analysis of randomized controlled trials that tested GLP-1 RA treatment vs. placebo in individuals with type 2 diabetes (T2D) or with overweight/obesity status, with or without CKD, with kidney events reported as primary or secondary endpoints. The primary outcome was the occurrence of worsening kidney function, defined as either a doubling of serum creatinine or a ≥40% or ≥50% decline in estimated glomerular filtration rate (eGFR), according to each study report. Secondary outcomes included development of persistent macroalbuminuria and a composite of worsening kidney function or the development of persistent macroalbuminuria. Subgroup analyses were performed by eGFR and albuminuria categories. The results are presented as risk ratios (RR) with 95% confidence intervals (CI). Results: Eight trials were eligible, including a total of 68,572 patients, of which 34,042 (49.6%) received GLP-1 RA treatment. During follow-up, 1,028 participants receiving GLP-1 RA (3.0%) and 1,150 participants receiving placebo (3.5%) experienced worsening kidney function. Treatment with GLP-1 RA (vs placebo) resulted in a reduction in the risk of worsening kidney function (RR, 0.84; 95%CI, 0.77-0.91; p<0.001). Additionally, treatment with GLP-1 RA significantly reduced the risk of developing persistent macroalbuminuria and the risk of the composite outcome of worsening kidney function or development of persistent macroalbuminuria. The results were consistent in patients with and without CKD. Conclusions: In conclusion, our meta-analysis suggests that GLP-1 RA reduce kidney disease progression in T2D or overweight/obesity regardless of CKD status. Copyright © 2024 by the American Society of Nephrology...