Evaluation of effects of glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors on estimated glomerular filtration rate, albuminuria and weight in diabetic kidney disease: A prospective cohort study

Introduction: Albuminuria and baseline estimated glomerular filtration rate (eGFR) are the main predictors for progression of diabetic kidney disease (DKD). Objectives: The objectives of the study were to assess the effects of GLP1-RA (glucagon-like peptide-1 receptor agonists) and SGLT2i inhibitors therapy on estimated GFR, albuminuria, and weight in patients with DKD stage 3 and 4. Patients and Methods: This was a prospective cohort study of patients with stage 3 and 4 DKD over 6 months at Basra teaching hospital from November 1, 2020, to May 1, 2020. Baseline weight, UACR (urine albumin creatinine ratio), and eGFR were measured, and 6-months values were assessed between and within the group. Results: The baseline characteristics for the GLP-1 RA (GLP-1 receptor agonists) versus SGLT2i (sodium-glucose co-transporter-2 inhibitors) groups were mean ages 65 years versus 62.5 years, male (54.5% versus 50%), median weight (75 versus 80 kg), median eGFR (23.5 versus 39 ml/min/1.73 m2 ) and median UACR (925 mg/g versus 327 mg/g). In the GLP-1 RA group, after 6-months of therapy, there was 32% increase in eGFR (P<0.001), 29% decrease in UACR (P<0.001) and 4.5% decrease in weight while in the SGLT2i group, there was 4.5% decrease in eGFR (P=0.345), 34% decrease in UACR (P<0.001) and 2.8% decrease in weight (P=0.005). With cox-regression analysis, the HR for eGFR decline with SGLT2i therapy was 3.25 (95% CI: 1.1-9.97; P=0.039). Conclusion: GLP-1 RA, compared to SGLT2i therapy, caused an increase in eGFR in stages 3 and 4 CKD and caused more weight reduction but slightly less albuminuria reduction.