Clemens Kristin K, Ernst Jaclyn, Khan Tayyab, Reichert Sonja, Khan Qasim, LaPier Heather, Chiu Michael, Stranges Saverio, Sahi Gurleen, Castrillon-Ramirez Fabio, Moist Louise
Department of Medicine, Division of Endocrinology and Metabolism, Western University, 268 Grosvenor Street, N6A 4V2, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, 1465 Richmond Street, N6G 2M1, London, Ontario, Canada; Centre for Diabetes, Endocrinology and Metabolism, St. Joseph's Health Care London, 268 Grosvenor Street, N6A 4V2, London, Ontario, Canada; ICES Western, 800 Commissioners Road East, N6A 5W9, London, Ontario, Canada; Lawson Health Research Institute, 750 Base Line Road East, Suite 300, N6C 2R5, London, Ontario, Canada; Department of Medicine, Western University, 800 Commissioners Road East, N6A 5W9, London, Ontario, Canada.
Department of Medicine, Western University, 800 Commissioners Road East, N6A 5W9, London, Ontario, Canada.
Nutr Metab Cardiovasc Dis. 2023 Jun;33(6):1111-1120. doi: 10.1016/j.numecd.2023.03.023. Epub 2023 Apr 5.
Glucagon-like peptide 1 receptor agonists (GLP-1RA) improve glycemic control and promote weight loss in type 2 diabetes (DM2) and obesity. We identified studies describing the metabolic benefits of GLP-1RA in end-staged kidney disease (ESKD) and kidney transplantation.
We searched for randomized controlled trials (RCTs) and observational studies that investigated the metabolic benefits of GLP-1RA in ESKD and kidney transplantation. We summarized the effect of GLP-1RA on measures of obesity and glycemic control, examined adverse events, and explored adherence with therapy. In small RCTs of patients with DM2 on dialysis, liraglutide for up to 12 weeks lowered HbA1c by 0.8%, reduced time in hyperglycemia by ∼2%, lowered blood glucose by 2 mmol/L and reduced weight by 1-2 kg, compared with placebo. In prospective studies inclusive of ESKD, 12 months of semaglutide reduced HbA1c by 0.8%, and contributed to weight losses of 8 kg. In retrospective cohort studies in DM2 and kidney transplantation, 12 months of GLP-1RA lowered HbA1c by 2%, and fasting glucose by ∼3 mmol/L compared with non-use, and in some reports, weight losses of up to 4 kg were described. Gastrointestinal (GI) side effects were most commonly reported, with hypoglycemia described with GLP-1RA in hemodialysis, particularly in those using insulin.
GLP-1RA are growing in popularity in those with DM2 and obesity. In small RCTs and observational cohort studies modest glycemic and weight benefits have been described in ESKD and transplantation, but GI side effects may limit adherence. Larger and longer term studies of GLP-1RA remain important.
胰高血糖素样肽1受体激动剂（GLP-1RA）可改善2型糖尿病（DM2）和肥胖症患者的血糖控制并促进体重减轻。我们检索了描述GLP-1RA在终末期肾病（ESKD）和肾移植中的代谢益处的研究。
我们检索了调查GLP-1RA在ESKD和肾移植中的代谢益处的随机对照试验（RCT）和观察性研究。我们总结了GLP-1RA对肥胖和血糖控制指标的影响，检查了不良事件，并探讨了治疗依从性。在针对透析的DM2患者的小型RCT中，与安慰剂相比，使用利拉鲁肽长达12周可使糖化血红蛋白（HbA1c）降低0.8%，高血糖时间减少约2%，血糖降低2 mmol/L，体重减轻1-2 kg。在纳入ESKD的前瞻性研究中，司美格鲁肽治疗12个月可使HbA1c降低0.8%，并导致体重减轻8 kg。在DM2和肾移植的回顾性队列研究中，与未使用GLP-1RA相比，使用12个月可使HbA1c降低2%，空腹血糖降低约3 mmol/L，在一些报告中，描述了体重减轻高达4 kg。胃肠道（GI）副作用是最常报告的，血液透析中使用GLP-1RA时会出现低血糖，尤其是在使用胰岛素的患者中。
GLP-1RA在DM2和肥胖症患者中越来越受欢迎。在小型RCT和观察性队列研究中，已描述了GLP-1RA在ESKD和移植中具有适度的血糖和体重益处，但胃肠道副作用可能会限制治疗依从性。对GLP-1RA进行更大规模和更长期的研究仍然很重要。
