Abstract
Type 2 diabetes mellitus (T2DM) represents the main cause of chronic kidney disease (CKD) and end-stage renal disease (ESKD), and diabetic kidney disease (DKD) is a major cause of morbidity and mortality in diabetes. Despite advances in the nephroprotective treatment of T2DM, DKD remains the most common complication, driving the need for renal replacement therapies (RRT) worldwide, and its incidence is increasing. Until recently, prevention of DKD progression was based around strict blood pressure (BP) control, using renin–angiotensin system blockers that simultaneously reduce BP and proteinuria, adequate glycemic control and control of cardiovascular risk factors. Glucagon-like peptide-1 receptor agonists (GLP-1RA) are a new class of anti-hyperglycemic drugs shown to improve cardiovascular and renal events in DKD. In this regard, GLP-1RA offer the potential for adequate glycemic control in multiple stages of DKD without an increased risk of hypoglycemia, preventing the onset of macroalbuminuria and slowing the decline of glomerular filtration rate (GFR) in diabetic patients, also bringing additional benefit in weight reduction, cardiovascular and other kidney outcomes. Results from ongoing trials are pending to assess the impact of GLP-1RA treatments on primary kidney endpoints in DKD.
Highlights
Chronic kidney disease (CKD) is among the most common complications of type 2 diabetes mellitus (T2DM)
Our review will focus on the potential role of glucagon-like peptide-1 receptor agonists (GLP-1RA) as nephroprotective agents in T2DM
The incretin effect describes the phenomenon whereby, in healthy individuals, oral glucose elicits higher insulin secretory responses than intravenous glucose, despite inducing similar levels of glycemia. This effect, which is uniformly defective in T2DM patients, is mediated by the gut-derived incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1)
Summary
Chronic kidney disease (CKD) is among the most common complications of type 2 diabetes mellitus (T2DM). 28% to 43% of patients with T2DM have CKD, defined as either a glomerular filtration rate (GFR) below 60 mL/min/1.73 m2 or a urinary albumin to creatinine ratio (UACR) >30 mg/g [1,2] In pivotal studies such as UKPDS (UK Prospective Diabetes Study), 25% of T2DM patients developed microalbuminuria within 10 years of diagnosis. Despite advances in the nephroprotective treatment of T2DM, DKD remains the most common complication, and its incidence keeps increasing, driving the need for RRT worldwide [6,7]. It is, vital to optimize risk stratification and therapeutic strategies for both DM2 and DKD patients in order to decrease associated morbimortality, mainly from cardiovascular disease, and the need for RRT. Our review will focus on the potential role of glucagon-like peptide-1 receptor agonists (GLP-1RA) as nephroprotective agents in T2DM
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
