Kidney outcomes with incretin receptor agonists in chronic kidney disease
In adults with type 2 diabetes and chronic kidney disease, what is the effect of a glucagon-like peptide-1 receptor agonist on kidney outcomes?
§1Abstract
§1.1Review question
In adults with type 2 diabetes and chronic kidney disease, what is the effect of a glucagon-like peptide-1 receptor agonist on kidney outcomes?
§1.2PICO frame
Table 1. The registered PICO frame. Any change made after protocol registration is recorded in the amendment log at §5 and is identified there as post hoc.
| Element | As registered |
|---|---|
| Population | Adults with type 2 diabetes and chronic kidney disease defined by estimated glomerular filtration rate and albuminuria criteria. |
| Intervention | A glucagon-like peptide-1 receptor agonist added to standard care including renin–angiotensin system blockade. |
| Comparator | Placebo added to standard care. |
| Outcomes | Composite kidney outcome; annual estimated glomerular filtration rate slope; kidney replacement therapy; death from kidney causes. |
§1.3Method in brief
A review of the effects of an intervention on pre-specified outcomes, with a quantitative synthesis where the contributing studies are sufficiently similar. The protocol was registered with the Institute's secretariat before the search was executed. The search was run on 2 September 2025 across 8 sources and is reproduced in full at §2. Screening, extraction and certainty assessment were performed independently by two members of the secretariat with disagreement resolved by a third.[1]
§1.4Conclusion
High certainty evidence from one dedicated event-driven trial, supported by kidney outcomes collected within cardiovascular outcome trials, indicates a reduction in the composite kidney outcome. The dedicated trial was stopped early for efficacy, which the Institute records as a source of modest effect-size inflation, and the estimate is reproduced with that qualification wherever it appears in the document set.
The conclusion rests on 14 contributing studies, listed with their extracted data at §3 and summarised outcome by outcome at §4.
§1.5Limitations
§1.6Consultation
This review was released for public comment before ratification. Draft synthesis: Kidney outcomes with incretin receptor agonists in chronic kidney disease received 11 submissions. Amendments arising are recorded in the amendment log and are traceable to a numbered submission.
References cited on this page
References are numbered in order of first citation in this document. Each superscript in the text links to its entry below.
- Perkovic V, Tuttle KR, Rossing P, Mahaffey KW, Mann JFE, Bakris G, Baeres FMM, Idorn T, Bosch-Traberg H, Lausvig NL, Pratley R. Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes. New England Journal of Medicine 2024;391(2):109–121. doi:10.1056/NEJMoa2403347 · PMID 38785209
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