Cao Yongsheng, Zhao Jianqin, Ma Yanjuan, Cao Shujie, Liu Ying
Department of Neurology, Sunshine Union Hospital, Weifang, Shandong, People's Republic of China.
Department of Endocrinology, Sunshine Union Hospital, Weifang, Shandong, People's Republic of China.
Diabetes Metab Syndr Obes. 2024 Aug 1;17:2913-2921. doi: 10.2147/DMSO.S472968. eCollection 2024.
Cardiovascular outcome trials indicate renal benefits of glucagon-like peptide-1 receptor agonists (GLP-1RAs); however, real-world efficacy and safety studies in Diabetic kidney disease (DKD) are scarce.
This retrospective, single-arm real-world trial involved adults with DKD treated with GLP-1RA for at least 6 months. The primary endpoint was hemoglobin A1c (HbA1c) levels after 6 months.
This study included a total of 364 patients with DKD, 153 (42.0%) of whom were female. The median disease duration was 8.0 years, and the mean values of age, HbA1c level, body mass index, and the urinary albumin-to-creatinine ratio (UACR) were 52.1 years, 8.6%, 27.8 kg/m, and 88.0 mg/g, respectively. Additionally, 73.6% and 26.4% of patients had mild and moderate DKD, respectively. Following 6 months of GLP-1RA treatment, the mean HbA1c level and UACR declined by 1.77% and 40.3%, respectively (both < 0.001). Compared to their baseline values, patients exhibited significant improvements in 24-h urinary protein, estimated glomerular filtration rate (eGFR), fasting blood glucose, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (all < 0.001). Patients with a disease duration of <10 years had more pronounced changes in the HbA1c level, UACR, and eGFR (all < 0.001) than those with a disease duration of ≥10 years. Changes in SBP and DBP were more pronounced in patients also taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEis/ARBs) than in those not taking ACEis/ARBs, whereas the changes in UACR and eGFR did not significantly differ.
Six-month GLP-1RA treatment improves glucose, blood pressure, lipids, and body weight in patients with mild-to-moderate DKD while slowing down kidney disease progression. It independently reduces proteinuria beyond ACEi/ARB impact, with early use yielding faster outcomes, supporting evidence-based practice.
心血管结局试验表明胰高血糖素样肽-1受体激动剂（GLP-1RAs）对肾脏有益；然而，糖尿病肾病（DKD）的真实世界疗效和安全性研究却很匮乏。
这项回顾性、单臂真实世界试验纳入了接受GLP-1RA治疗至少6个月的成年DKD患者。主要终点是6个月后的糖化血红蛋白（HbA1c）水平。
本研究共纳入364例DKD患者，其中153例（42.0%）为女性。疾病中位病程为8.0年，年龄、HbA1c水平、体重指数和尿白蛋白与肌酐比值（UACR）的平均值分别为52.1岁、8.6%、27.8kg/m²和88.0mg/g。此外，73.6%和26.4%的患者分别患有轻度和中度DKD。GLP-1RA治疗6个月后，平均HbA1c水平和UACR分别下降了1.77%和40.3%（均P<0.001）。与基线值相比，患者的24小时尿蛋白、估算肾小球滤过率（eGFR）、空腹血糖、体重、收缩压（SBP）、舒张压（DBP）、总胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇均有显著改善（均P<0.001）。病程<10年的患者在HbA1c水平、UACR和eGFR方面的变化（均P<0.001）比病程≥10年的患者更明显。同时服用血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂（ACEis/ARBs）的患者SBP和DBP的变化比未服用ACEis/ARBs的患者更明显，而UACR和eGFR的变化无显著差异。
6个月的GLP-1RA治疗可改善轻度至中度DKD患者的血糖、血压、血脂和体重，同时减缓肾病进展。它独立于ACEi/ARB的作用降低蛋白尿，早期使用效果更快，支持循证实践。
