Game-changer for chronic kidney disease: Largest study confirms benefit of GLP-1 agonists, set to redefine clinical guidelines

The most comprehensive analysis to date on glucagon-like peptide-1 (GLP-1) receptor agonists highlights significant benefits for kidney and cardiovascular health, extending to individuals with and without diabetes.

Originally developed to treat diabetes, GLP-1 receptor agonists mimic the hormone glucagon-like peptide-1, stimulating insulin production and lowering blood sugar levels. More recently, they have gained recognition as effective treatments for obesity by slowing digestion, increasing satiety, and reducing hunger.

While their benefits for type 2 diabetes, obesity, and cardiovascular disease are well established, the impact of GLP-1 receptor agonists on chronic kidney disease (CKD) has been less clear – until now.

“This is the first study to show a clear benefit of GLP-1 receptor agonists on kidney failure or end-stage kidney disease, suggesting they have a key role in kidney-protective and heart-protective treatment for patients with common medical conditions like type 2 diabetes, overweight or obesity with cardiovascular disease, or CKD,” said lead author Professor Sunil Badve, Professorial Fellow at The George Institute for Global Health and UNSW Sydney.

Australian researchers conducted a meta-analysis of 11 large-scale clinical trials involving 85,373 participants, including 67,769 individuals with type 2 diabetes and 17,604 with overweight or obesity and cardiovascular disease but without diabetes. The trials evaluated seven GLP-1 receptor agonists, including semaglutide (Ozempic, Wegovy), dulaglutide (Trulicity), and liraglutide (Victoza).

The findings reveal compelling kidney-protective effects. Compared to placebo, GLP-1 receptor agonists reduced the risk of kidney failure by 16% and slowed worsening kidney function by 22%, measured by a drop in estimated glomerular filtration rate (eGFR) of at least 50%. The combined risk reduction for kidney failure, declining kidney function, and death due to kidney disease was 19%.

The study also confirmed cardiovascular benefits, with GLP-1 receptor agonists reducing the risk of cardiovascular death, non-fatal heart attack, and non-fatal stroke by 14%. Overall mortality dropped by 13% among those treated with these drugs.

“These results are particularly important for patients with chronic kidney disease. It is a progressive condition eventually leading to kidney failure requiring dialysis or kidney transplantation and is associated with premature death, mostly from heart disease. It has a significant impact on patients’ quality of life and incurs substantial healthcare costs,” Professor Badve added.

Chronic kidney disease is a growing global health challenge, affecting an estimated one in ten people – approximately 850 million worldwide. It is the tenth leading cause of death globally and is projected to rank fifth by 2050. CKD is closely linked to diabetes, cardiovascular disease, and obesity, which are major contributors to the global health burden.

Professor Vlado Perkovic, senior author of the study, Professorial Fellow at The George Institute, and Provost at UNSW Sydney, emphasised the broader implications of the findings.

“This research shows that GLP-1 receptor agonists could play an important role in addressing the global burden of non-communicable diseases. Our study will have a major impact on clinical guidelines for the management of chronic kidney disease and cardiovascular disease in people with and without diabetes,” he said.

“More work is now needed to implement the results of this study into clinical practice and improve access to GLP-1 receptor agonists to people who will benefit from them,” Professor Perkovic concluded.

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