Nephrology · 2 h ago
GLP-1 therapies show emerging kidney benefits in nondiabetic CKD
This review examines potential kidney-protective mechanisms of GLP-1 receptor agonists and multi-hormone receptor modulators in people with chronic kidney disease without diabetes. Evidence to date comes mainly from secondary kidney endpoints in phase 3 obesity and cardiovascular trials; dedicated kidney-outcome studies are underway.
- Review summarizes proposed direct and indirect kidney effects.
- Clinical evidence comes from secondary endpoints in phase 3 trials.
- Dedicated kidney-outcome studies are underway.
People with chronic kidney disease who do not have diabetes have limited evidence for GLP-1-based therapies as kidney-protective treatment. This review summarizes proposed mechanisms and emerging clinical findings for GLP-1 receptor agonists and newer multi-hormone receptor modulators targeting GIP, glucagon and amylin. It does not report a new trial or pooled sample size.
Proposed direct effects include natriuresis through inhibition of the sodium-hydrogen exchanger NHE-3, changes in glomerular hemodynamics and reduced renal inflammation. Indirect effects may include lower metabolic and hemodynamic burden through weight loss, blood pressure reduction and improved heart failure. In people without diabetes, the clinical evidence cited comes from secondary kidney endpoints in phase 3 obesity and cardiovascular outcome trials, including reductions in albuminuria and preservation of estimated glomerular filtration rate.
The review notes that the interactions among the different hormonal targets remain incompletely understood. Because the current evidence relies on secondary endpoints, it does not establish kidney-outcome efficacy in dedicated trials. Ongoing outcome studies are expected to clarify whether these treatments have a role in nondiabetic kidney disease.
In practice
For people with CKD without diabetes, GLP-1 receptor agonists and multi-hormone receptor modulators have shown signals of kidney benefit in secondary endpoints from phase 3 obesity and cardiovascular trials, including lower albuminuria and preservation of estimated glomerular filtration rate. These findings do not yet establish benefit on dedicated kidney outcomes or justify treating these agents as established kidney-protective therapy in this population. Dedicated outcome studies are underway, and the physiological effects of the added hormone targets remain incompletely understood.
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Journal of the American Society of Nephrology: Glucagon-Like Peptide-1 Receptor Agonists and Multi-hormone Receptor Modulators for Kidney Protection in Nondiabetic Kidney Disease ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.