The effect of GLP-1 receptor agonists on renal outcomes: a systematic review and meta-analysis.

We aimed to assess the effects of GLP1-RAs on renal outcomes in patients with or without diabetes.

我们的目标是评估GLP1-RAs对有或没有糖尿病患者肾脏结果的影响。

Methods

We performed a systematic reviewand meta-analysiswith Medline, EMBASE and the Cochrane Register searched to December 2024.

我们进行了系统综述和荟萃分析，检索了Medline、EMBASE和Cochrane注册库至2024年12月。

The primary outcome was the composite of kidney failure (defined as estimated glomerular filtration rate <15 mL/min/1.73 m2) or dialysis requirement, worsening of renal function and changes in proteinuria.

主要结果是肾功能衰竭（定义为估算的肾小球滤过率<15 mL/min/1.73 m²）或需要透析、肾功能恶化和蛋白尿变化的复合指标。

Subgroup analysis was performed based on diabetic status, a (CKD) and individual GLP1-RA drugs.

根据糖尿病状态、慢性肾脏病(CKD)和个体GLP1-RA药物进行了亚组分析。

Relative risks (RR) with 95% confidence intervals (CI) for individual trials were pooled using random effects models.

使用随机效应模型汇总了各个试验的相对风险(RR)及其95%置信区间(CI)。

Results

We identified 19 trials including 90 882 patients.

我们确定了19项试验，共纳入90,882名患者。

Mean age was 60.8 years and mean follow-up was 25.9 months.

平均年龄为60.8岁，平均随访时间为25.9个月。

GLP1-RAs were associated with a 19% reduction in the risk of primary renal outcome (RR 0.81, 95% CI 0.73-0.89), a 12% reduction in renal functional decline (RR 0.88, 95% CI 0.81-0.95) and a 0.45 mL/min/1.73 m2 reduction in yearly loss [16 trials, mean difference (MD) 0.45, 95% CI 0.10-0.81].

GLP1-RAs与降低主要肾脏结果风险19%相关（RR 0.81，95% CI 0.73-0.89），降低肾功能下降风险12%（RR 0.88，95% CI 0.81-0.95），以及每年损失减少0.45 mL/min/1.73 m2 [16项试验，平均差异（MD）0.45，95% CI 0.10-0.81]。

GLP1-RAs also reduced microalbuminuria by 24% (RR 0.76, 95% CI 0.71-0.82), HbA1c (units: %) by 0.61 (MD -0.61, 95% CI -0.76 to -0.49) and body weight by 5 kg (MD -5.24, 95% CI -7.46 to -3.02).

GLP1-RAs还使微量白蛋白尿降低24%（RR 0.76，95% CI 0.71-0.82），HbA1c（单位：%）降低0.61（MD -0.61，95% CI -0.76 至 -0.49）以及体重减轻5公斤（MD -5.24，95% CI -7.46 至 -3.02）。

Although there were no significant differences in progression to kidney failure (RR 0.86, 95% CI 0.71-1.05), GLP1-RAs reduced the incidenceof major adverse cardiovascular events by 15% (RR 0.85, 95% CI 0.81-0.90) and all-cause mortality by 14% (RR 0.86, 95% CI 0.82-0.91).

尽管在肾功能衰竭进展方面没有显著差异（相对风险 RR 0.86，95% 置信区间 CI 0.71-1.05），GLP1-RAs 减少了主要不良心血管事件的发生率15%（RR 0.85，95% CI 0.81-0.90）和全因死亡率14%（RR 0.86，95% CI 0.82-0.91）。

No significant differences were seen in severe adverse events (RR 0.96, 95% CI 0.90-1.01).

在严重不良事件方面没有看到显著差异（相对风险 RR 0.96，95% 置信区间 CI 0.90-1.01）。

However, there were more gastroenterological side effects.

然而，胃肠道副作用更多。

Conclusions

GLP1-RAs demonstrated cardiovascular and renal benefits.

GLP1-RAs显示出心血管和肾脏的益处。

Further high-quality randomized trials assessing their effects in patients without diabetes, with or without proteinuria and/or CKD are needed.

需要进一步开展高质量的随机试验，评估这些药物在无糖尿病患者以及有或无蛋白尿和/或慢性肾脏病（CKD）患者中的效果。