GLP-1-Receptor Agonists in Patients with Diabetic Kidney Disease: A literature review

Abstract

Diabetic Kidney Disease (DKD) is a microvascular complication of Diabetes Mellitus and is, furthermore, the leading cause of Chronic Kidney Disease (CKD) and End-Stage Kidney Disease (ESKD). Globally, the prevalence of Diabetes Mellitus is increasing and consequently, the Diabetic Kidney Disease prevalence, is predicted to increase. Although, patients receiving an optimal treatment, many still progresses in the illness, commonly resulting in End Stage Kidney Disease. The increasing public health concern emphasizes the critical need for more targeted and effective therapies. This literature review mainly aimed to understand the role and effect of GLP-1 Receptor Agonists in patients with Diabetic Kidney Disease by evaluating the renal outcomes and the potential renal protective effects. The hypothesis of this paper was that the injectable GLP-1 Receptor Agonists, Liraglutide, Semaglutide and Dulaglutide, improves the renal outcomes and slows the progression of Diabetic Kidney Disease. The PubMed and ClinicalKey were the databases conducted reviewing articles and major clinical trials using the keywords including ‘GLP-1 Receptor Agonists’ in conjunction with ‘Diabetic Kidney Disease’, ‘renal outcomes’, and ‘renal protective effect’. Furthermore, four main clinical trials such as the LEADER, SUSTAIN-6, FLOW and REWIND trials, were reviewed and evaluated in this paper, evaluating their renal outcomes in patients with Diabetic Kidney Disease using the injectable GLP-1 Receptor Agonists Liraglutide, Semaglutide and Dulaglutide. The results of this literature review showed that the addition of the injectable GLP-1 Receptor Agonists, Liraglutide, Semaglutide and Dulaglutide, to patients with Diabetes Mellitus Type 2 and DKD, improved the renal outcomes mainly by the reduction of the levels of albuminuria. In conclusion, further studies with primary kidney outcomes in patients with DKD are necessary as there currently is only one clinical trial available with primary kidney outcomes. Additionally, more studies regarding the direct renal effects caused by GLP-1 RA should be conducted.