Rehman Shuja Ur, Kolanu Nikhil Deep, Mushtaq Muhammad Muaz, Ali Husnain, Ahmed Zeeshan, Mushtaq Maham, Liaqat Maryyam, Sarwer Muhammad Asad, Bokhari Syed Faqeer Hussain, Ahmed Fazeel, Bakht Danyal
Internal Medicine, Al-Saba Hospital, Sheikhupura, PAK.
Internal Medicine, Allama Iqbal Teaching Hospital, Dera Ghazi Khan, PAK.
Cureus. 2024 Jul 7;16(7):e64038. doi: 10.7759/cureus.64038. eCollection 2024 Jul.
Diabetic kidney disease (DKD) is a prevalent microvascular complication of diabetes, posing a significant health burden. Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown promise in mitigating renal outcomes in DKD. This systematic review aimed to evaluate the renal effects of semaglutide in individuals with DKD. A comprehensive literature search identified six eligible studies, including two case reports and four cohorts, from diverse geographic locations. The primary outcomes assessed were changes in estimated glomerular filtration rate (eGFR) and albuminuria. Secondary outcomes included acute kidney injury (AKI) incidence and other renal biomarkers. The impact of semaglutide on eGFR was variable, with some studies reporting decreases and others showing improvements or no significant changes. Albuminuria, however, was more consistently reduced, particularly in patients with macroalbuminuria. Notably, the case reports described semaglutide-associated AKI, including acute interstitial nephritis, highlighting the need for careful monitoring during therapy. Beyond renal outcomes, semaglutide consistently improved glycemic control and promoted weight loss, with generally manageable gastrointestinal side effects. The findings suggest that semaglutide may effectively reduce albuminuria in DKD, potentially slowing disease progression. However, the risk of AKI and the variable impact on eGFR underscore the need for a personalized approach and vigilant monitoring, particularly in patients with advanced CKD. Future large-scale, long-term randomized controlled trials are warranted to definitively assess the renal benefits and risks of semaglutide in DKD.
糖尿病肾病（DKD）是糖尿病常见的微血管并发症，造成了重大的健康负担。司美格鲁肽是一种胰高血糖素样肽-1受体激动剂，已显示出在减轻DKD患者肾脏结局方面的前景。本系统评价旨在评估司美格鲁肽对DKD患者的肾脏影响。全面的文献检索确定了六项符合条件的研究，包括两项病例报告和四项队列研究，来自不同地理位置。评估的主要结局是估计肾小球滤过率（eGFR）和蛋白尿的变化。次要结局包括急性肾损伤（AKI）发生率和其他肾脏生物标志物。司美格鲁肽对eGFR的影响各不相同，一些研究报告其下降，而其他研究显示改善或无显著变化。然而，蛋白尿更一致地减少，尤其是在大量蛋白尿患者中。值得注意的是，病例报告描述了司美格鲁肽相关的AKI，包括急性间质性肾炎，突出了治疗期间仔细监测的必要性。除了肾脏结局外，司美格鲁肽持续改善血糖控制并促进体重减轻，胃肠道副作用总体上易于管理。研究结果表明，司美格鲁肽可能有效降低DKD患者的蛋白尿，可能减缓疾病进展。然而，AKI的风险以及对eGFR的不同影响强调了个性化方法和密切监测的必要性，特别是在晚期慢性肾脏病患者中。未来有必要进行大规模、长期的随机对照试验，以明确评估司美格鲁肽在DKD中的肾脏益处和风险。
