The use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) appears to be beneficial for patients with type 2 diabetes mellitus (T2DM) and advanced chronic kidney disease (CKD), according to study results presented at the American Society of Nephrology’s Kidney Week 2023 meeting.
To better understand the effects of GLP-1RAs on patients with T2DM and advanced CKD (stage 5 or end-stage kidney disease undergoing hemodialysis or peritoneal dialysis), researchers conducted a literature search to identify clinical trials and cohort studies that reported on measures such as blood glucose control, weight reduction, cardiovascular outcomes, and death.
In total, 27,639 patients from 8 studies were included in the meta-analysis. Across these studies, liraglutide was found to be the most commonly used GLP-1RA, followed by dulaglutide. Median follow-up time was reported to be 3 months (range, 5 weeks to 4 years). Patients receiving dipeptidyl peptidase 4 inhibitors, insulin, or placebo made up the control groups.
Findings showed in T2DM patients with advanced CKD, GLP-1RAs significantly reduced cardiothoracic ratio (standardized mean difference [SMD] of -1.2% [95% CI, -2.0, -0.4]; I2 =0%; 2 studies) and pro-BNP (SMD -335.9pmol/L [95% CI, -438.9, -232.8]; I2 =12%; 2 studies) compared with baseline.
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Additionally, GLP-1RAs were associated with significant reductions in mean blood glucose (SMD -1.1mg/dL [95% CI, -1.8, -0.3; I2 =0%; 2 studies) and weight (SMD -2.2kg [95% CI, -2.9, -1.5; I2 =0%; 3 studies) when compared with controls. No significant reductions were observed in systolic blood pressure or HbA1c.
During the 1-year follow-up period, there were no reports of death, myocardial infarction, stroke, or heart failure in any of the studies included in the analysis.
With regard to safety, hypoglycemia risk was not significantly increased with GLP-1RAs when compared with controls (odds ratio, 1.8 [95% CI, 5.1-0.6]; I2 =48%; 3 studies). However, the incidence rates of nausea and vomiting were found to be higher with GLP-1RAs compared with controls.
“While GLP-1RAs might increase the risk of gastrointestinal side effects, there is a significant benefit on cardiovascular outcomes, blood glucose control and weight reduction,” the researchers concluded.
This article originally appeared on MPR