von Scholten Bernt Johan, Hansen Tine Willum, Goetze Jens Peter, Persson Frederik, Rossing Peter
Steno Diabetes Center, Gentofte, Denmark.
Steno Diabetes Center, Gentofte, Denmark.
J Diabetes Complications. 2015 Jul;29(5):670-4. doi: 10.1016/j.jdiacomp.2015.04.004. Epub 2015 Apr 11.
In a short-term study including 31 patients with type 2 diabetes, glucagon-like peptide 1 receptor agonist (GLP-1 RA) treatment was associated with a significant reversible decline in GFR. Twenty-three patients re-initiated GLP-1 RA treatment after the primary study, and the aim was to investigate the long-term effect on kidney function.
We included 30 patients in a one-year extension study, all initially treated with liraglutide for seven weeks. During follow-up 23 were treated with liraglutide and seven untreated. Primary outcome was change in GFR ((51)Cr-EDTA plasma clearance).
Patients were 61.5 (10.0) years and HbA(1c) 60.1 (13.8) mmol/mol. Baseline GFR was 100.6 (24.9) mL/min/1.73 m(2) and was reduced by 11 (95% CI: 6.6-15.7, p < 0.001) mL/min/1.73 m(2), independent of change in 24-h systolic blood pressure (SBP), weight, UAER or HbA(1c) (p≥0.33). Geometric mean (IQR) of UAER was 25.5 (9.9-50.9) mg/d and was reduced by 27 (95% CI: 5-44; p = 0.020)%, and 24-h SBP was reduced by 8.2 (p = 0.048) mmHg. No changes occurred in untreated patients.
Long-term treatment with liraglutide was associated with a reduction in measured GFR similar to the effect during short-term treatment, suggesting a metabolic or haemodynamic reversible effect and not structural changes. Moreover, UAER and 24-h SBP were reduced.
ClinicalTrials.gov identifier: NCT01499108.
在一项纳入31例2型糖尿病患者的短期研究中，胰高血糖素样肽1受体激动剂（GLP-1 RA）治疗与肾小球滤过率（GFR）显著的可逆性下降有关。23例患者在初步研究后重新开始GLP-1 RA治疗，目的是研究其对肾功能的长期影响。
我们将30例患者纳入一项为期一年的扩展研究，所有患者最初均接受利拉鲁肽治疗7周。在随访期间，23例接受利拉鲁肽治疗，7例未接受治疗。主要结局为GFR（（51）Cr-EDTA血浆清除率）的变化。
患者年龄为61.5（10.0）岁，糖化血红蛋白（HbA1c）为60.1（13.8）mmol/mol。基线GFR为100.6（24.9）mL/（min/1.73 m²），降低了11（95%CI：6.6-15.7，p<0.001）mL/（min/1.73 m²），与24小时收缩压（SBP）、体重、尿白蛋白排泄率（UAER）或HbA1c的变化无关（p≥0.33）。UAER的几何均值（四分位间距）为25.5（9.9-50.9）mg/d，降低了27（95%CI：5-44；p=0.020）%，24小时SBP降低了8.2（p=0.048）mmHg。未治疗患者未出现变化。
长期使用利拉鲁肽治疗与测量的GFR降低有关，类似于短期治疗期间的效果，提示存在代谢或血流动力学的可逆性影响而非结构改变。此外，UAER和24小时SBP降低。
ClinicalTrials.gov标识符：NCT01499108。
