Kidney and Cardiovascular Outcomes Among Patients With CKD Receiving GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of Randomized Trials

RATIONALE & OBJECTIVE: Glucagon-like peptide 1 (GLP-1) receptor agonists improve cardiac and kidney outcomes in patients with diabetes; however, their efficacy in individuals with reduced estimated glomerular filtration rate (eGFR) is uncertain. This study evaluated the effects of GLP-1 receptor agonists on kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD). STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials (RCTs) reported through May 25, 2024. SETTING & STUDY POPULATIONS: . SELECTION CRITERIA FOR STUDIES: were included. DATA EXTRACTION: Two independent investigators extracted the data. ANALYTICAL APPROACH: Pooled odds ratios (ORs) for composite kidney outcome, all-cause mortality, and composite CV outcome were estimated using random-effects models. Evidence certainty was assessed using the GRADE system. RESULTS: =40.3%). Sensitivity analyses restricted to human GLP-1 backbone agents showed enhanced benefits. LIMITATIONS: Inconsistent kidney outcome definitions, focus on diabetic populations in most studies, and potential publication bias. CONCLUSIONS: GLP-1 receptor agonists improved kidney and CV outcomes, and survival in patients with CKD enrolled in an array of clinical trials. REGISTRATION: Registered at PROSPERO with identification number CRD42023449059. PLAIN-LANGUAGE SUMMARY: Glucagon-like peptide 1 (GLP-1) receptor agonists reduce body weight and improve glycemic control. They also have been shown to protect the heart and kidney in people with diabetes. However, the extrapolation of these findings to those with chronic kidney disease (CKD) is uncertain. This study meta-analyzed data from clinical trials focusing on patients with CKD and noted that GLP-1 receptor agonists may slow kidney disease progression and lower the risk of heart disease, stroke, and death. These findings suggest that GLP-1 receptor agonists offer multiple kidney and cardiovascular benefits to people with CKD.