GLP-1 receptor agonists linked to kidney failure prevention: Study

A new Australian meta-analysis of more than 85,000 patients, including those with and without diabetes, found GLP-1 receptor agonists reduced the risk of kidney failure by 16%, and the worsening of kidney function by 22%.
 
Published this week in The Lancet Diabetes & Endocrinology, the research findings looked at 11 large-scale trials investigating seven medications in the GLP-1 receptor agonist class, including semaglutide (sold as Ozempic or Wegovy), dulaglutide (sold as Trulicity), and liraglutide (sold as Victoza).
 
Of the 85,373 people included, 67,769 had type 2 diabetes and 17,604 people lived with obesity or cardiovascular risk, but without diabetes.
 
The results showed that compared to a placebo, the combined reduction in the risk of kidney failure, worsening kidney function, and death due to kidney disease was 19%.
 
They also found the GLP-1 receptor agonists led to a 14% reduction in the risk of cardiovascular death, non-fatal heart attack, and non-fatal stroke.
 
Death by any cause was 13% lower among patients treated with GLP-1 receptor agonists.
 
Lead author Professor Sunil Badve told newsGP he now hopes the study will have a ‘major impact’ for patients.
 
‘These medications have an important role to play in patients with chronic kidney disease [CKD], with or without diabetes, as well as those with cardiovascular disease,’ he said.
 
‘We know that for these patients with obesity, diabetes, CKD, cardiovascular disease [CVD], these are really not isolated or distinct entities.’
 
However, the research comes at a time when supply chain issues for the GLP-1 receptor agonists have been pronounced and prolonged.
 
For example, a worldwide shortage of semaglutide started to affect Australia in 2022 when ‘Novo Nordisk could not supply enough Ozempic to meet an unexpected increase in demand due to off-label prescribing for weight loss’.
 
That shortage is expected to remain until at least the end of 2024.
 
The latest findings contribute to the growing evidence that GLP-1 receptor agonists will continue to have a place in healthcare through prevention of progression of diabetes, CVD and kidney disease.
 
‘We are expecting that GLP-1 receptor agonists will become the standard of care in these patient populations and those for who are at risk of kidney disease progression and CVD it should be used as a priority,’ Professor Badve said.

GPs are likely to play a key role in identifying people who will benefit from these medicines through preventive health actions, and through patient education and support.
 
Professor Badve said ‘education is a key factor,’ when it comes to patients starting and continuing with these medications.
 
He encourages clinicians to take the time to educate patients and says the studies also included low dose regimens, so starting with low doses and using very gradual increases may facilitate better long-term continuation and benefits.
 
As more research emerges, understanding of GLP-1 receptor agonists continues to grow – and Professor Badve likens them to the ACE inhibitors which similarly underwent a broadening of their list of indications over time. 
 
‘Probably these medications have multiple mechanisms of action rather than one single mechanism,’ he said.
 
‘Obviously, there is reduction in body weight, reduction in glucose levels, which may have contributed to a certain extent, but those alone do not explain the benefits that we are seeing. ‘
 
‘These medications have direct organ protective effects.’
 
However, he said more work is now needed to implement the results of the study into clinical practice and improve access to GLP-1 receptor agonists to people who will benefit from them.
 
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