Kidney and Cardiovascular Outcomes Among Patients With CKD Receiving GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of Randomized Trials.

This study evaluated the effects of GLP-1 receptor agonists on kidney and cardiovascular (CV) outcomes in patients with chronic kidney disease (CKD).

本研究评估了GLP-1受体激动剂对慢性肾脏病（CKD）患者肾脏和心血管（CV）结果的影响。

study_design

Systematic reviewand meta-analysisof randomized controlled trials (RCTs) reported through May 25, 2024.

截至2024年5月25日报告的随机对照试验(RCTs)的系统评价和荟萃分析。

SETTING & STUDY POPULATIONS: Adult participants in RCTs with baseline eGFR<60mL/min/1.73m2.

设置与研究人群：基线eGFR<60mL/min/1.73m2的成年参与者在随机对照试验(RCTs)中。

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<60mL/min/1.73m2, that compared GLP-1 receptor agonists with control treatments with respect to a composite kidney outcome, all-cause mortality, or a composite CV disease outcome.

随机对照试验(RCTs)包括了不同程度肾功能的成年人(≥18岁)，包括基线eGFR<60mL/min/1.73m2的慢性肾脏病(CKD)患者，这些试验比较了GLP-1受体激动剂与对照治疗在复合肾脏结果、全因死亡率或复合心血管疾病结果方面的差异。

From among 212 screened studies, 12 trials involving that included participants with baseline eGFR<60mL/min/1.73m2 were included.

在212项筛选的研究中，包括了12项试验，这些试验的参与者基线eGFR<60mL/min/1.73m2。

data_extraction

Two independent investigators extracted the data.

两位独立的研究人员提取了数据。

analytical_approach

Pooled odds ratios (ORs) for composite kidney outcome, all-cause mortality, and composite CV outcome were estimated using random-effects models.

使用随机效应模型估计了综合肾脏结果、全因死亡率和综合心血管结果的汇总比值比(ORs)。

Evidence certainty was assessed using the GRADE system.

使用GRADE系统评估了证据的确定性。

Results

The analyses included 17,996 RCT participants with baseline eGFR<60mL/min/1.73m2.

分析包括了17,996名基线eGFR小于60 mL/min/1.73m²的随机对照试验参与者。

GLP-1 receptor agonists were significantly associated with a reduced risk of the composite kidney outcome (OR, 0.85 [95% CI, 0.77-0.94]; P=0.001) with low heterogeneity (I2<0.01%).

GLP-1受体激动剂与复合肾脏结果风险降低显著相关（OR，0.85 [95% 置信区间，0.77-0.94]；P=0.001），异质性低（I2<0.01%）

GLP-1 receptor agonists were also associated with a reduced the risk of a>30% eGFR decline (OR, 0.78; P=0.004), a>40% decline (OR, 0.76; P=0.01), and a>50% decline (OR, 0.72; P<0.001).

GLP-1受体激动剂还与降低>30% eGFR下降风险相关（OR，0.78；P=0.004），>40%下降风险（OR，0.76；P=0.01），以及>50%下降风险（OR，0.72；P<0.001）

Risk of all-cause mortality was also lower in the GLP-1 receptor agonist group (OR, 0.77 [95% CI, 0.60-0.98], P=0.03), though there was high heterogeneity (I2=71.6%).

GLP-1受体激动剂组的全因死亡风险也较低（OR, 0.77 [95% 置信区间, 0.60-0.98], P=0.03），尽管存在高度异质性（I2=71.6%）。

Composite CV outcomes were also lower with the use of a GLP-1 receptor agonist (OR, 0.86 [95% CI, 0.74-0.99], P=0.03; I2=40.3%).

使用GLP-1受体激动剂的复合心血管结果也较低（OR, 0.86 [95% 置信区间, 0.74-0.99], P=0.03; I2=40.3%）。

Sensitivity analyses restricted to human GLP-1 backbone agents showed enhanced benefits.

仅限于人源GLP-1骨架药物的敏感性分析显示了增强的益处。

limitations

Inconsistent kidney outcome definitions, focus on diabetic populations in most studies, and potential publication bias.

不一致的肾脏结果定义，大多数研究关注糖尿病人群，以及潜在的出版偏倚。

Conclusions

GLP-1 receptor agonists improved kidney and CV outcomes, and survival in patients with CKD enrolled in an array of clinical trials.

GLP-1受体激动剂改善了慢性肾脏病患者的肾脏和心血管结局以及生存率，这些患者参与了一系列临床试验。

registration

Registered at PROSPERO with identification number CRD42023449059.

已在PROSPERO注册，注册编号为CRD42023449059。

PLAIN-LANGUAGE SUMMARY: Glucagon-like peptide 1 (GLP-1) receptor agonists reduce body weight and improve glycemic control.

简易语言总结：胰高血糖素样肽1（GLP-1）受体激动剂能减轻体重并改善血糖控制。

They also have been shown to protect the heart and kidney in people with diabetes.

此外，已有研究表明，GLP-1受体激动剂在糖尿病患者中具有保护心脏和肾脏的作用。

However, the extrapolation of these findings to those with chronic kidney disease (CKD) is uncertain.

然而，将这些发现外推到慢性肾脏病（CKD）患者身上是不确定的。

This study meta-analyzed data from clinical trials focusing on patients with CKD and noted that GLP-1 receptor agonists may slow kidney disease progression and lower the risk of heart disease, stroke, and death.

本研究对针对慢性肾脏病（CKD）患者的临床试验数据进行了荟萃分析，注意到胰高血糖素样肽-1（GLP-1）受体激动剂可能会减缓肾脏疾病进展，并降低心脏病、中风和死亡的风险。

These findings suggest that GLP-1 receptor agonists offer multiple kidney and cardiovascular benefits to people with CKD.

这些发现表明，GLP-1受体激动剂为慢性肾脏病患者提供了多种肾脏和心血管益处。