Kidney and Cardiovascular Outcomes Among Patients With CKD Receiving GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of Randomized Trials
Abstract
RATIONALE & OBJECTIVE
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) 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-1RAs 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
Adult participants in RCTs with baseline eGFR <60 mL/min/1.73 m2.
SELECTION CRITERIA FOR STUDIES
RCTs including adults (≥18 years old) with varying degrees of kidney function, including individuals with CKD characterized by a baseline eGFR of less than 60 mL/min/1.73 m2, that compared GLP-1RAs with control treatments with respect to a composite kidney outcome, all-cause mortality, or a composite CV disease outcome. From among 212 screened studies, 12 trials involving that included participants with baseline eGFR <60 mL/min/1.73 m2 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
17,996 RCT participants with baseline eGFR 30% eGFR decline (OR: 0.78, p=0.004), a >40% decline (OR: 0.76, p=0.01), and a…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 17,996 participants or records.
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