Riehl-Tonn Victoria J, Medak Kyle D, Rampersad Christie, MacPhee Anne, Harrison Tyrone G
Department of Medicine, University of Calgary, AB, Canada.
Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, AB, Canada.
Can J Kidney Health Dis. 2024 Oct 31;11:20543581241290317. doi: 10.1177/20543581241290317. eCollection 2024.
Diabetes is the most common cause of kidney disease in individuals that receive a kidney transplant, and those without pre-existing diabetes are at greater risk of developing diabetes following kidney transplant. A class of diabetes treatment medications called glucagon-like peptide-1 receptor agonists (GLP-1RA) has seen recent widespread use for people with diabetes or obesity, with efficacy for improved glycemic control, weight loss, and reduced risk of cardiovascular events. Given these benefits, and indications for use that often co-occur in kidney transplant recipients, use of GLP-1RAs warrants consideration in this population. Therefore, we sought to review the current literature to better understand the mechanisms of action, clinical application, and person-centred considerations of GLP-1RAs in kidney transplant recipients.
Original articles were identified between December 2023 and July 2024 from electronic databases including the Ovid MEDLINE database, PubMed, and Google Scholar using terms "kidney transplant," "GLP-1," "glucagon-like peptide-1 receptor agonist," and "diabetes."
A comprehensive review of the literature was conducted to explore the relationship between GLP-1RAs and kidney transplant recipients. We reviewed the current state of evidence across the research disciplines of basic or fundamental science, clinical and health services research, and person-centred equity science, and highlighted important knowledge gaps that offer opportunities for future research.
Numerous clinical studies have demonstrated the benefit of GLP-1RAs in people with and without diabetic kidney disease, including decreased risk of cardiovascular events. However, there is a paucity of high-quality randomized controlled trials and observational studies analyzing use of GLP-1RAs in kidney transplant recipients. Evidence of benefit in this population is therefore limited to small studies or inferred from research conducted in nontransplant populations. Growing evidence from preclinical and clinical studies may elucidate renoprotective mechanisms of GLP-1RAs and remove barriers to application of these drugs in the transplant recipient population. Individuals who are female, non-white, have lower socioeconomic status, and live in rural communities are at greater risk of diabetes and have lower uptake of GLP-1RAs. There is a need for clinical trials across diverse kidney transplant populations to estimate the efficacy of GLP-1RAs on important health outcomes.
The search strategy for this narrative review may not have been sensitive to identify all relevant articles. Our search was limited to English language articles.
糖尿病是接受肾移植患者中肾病最常见的病因，而那些无糖尿病病史的患者在肾移植后发生糖尿病的风险更高。一类名为胰高血糖素样肽-1受体激动剂（GLP-1RA）的糖尿病治疗药物最近在糖尿病或肥胖患者中广泛使用，具有改善血糖控制、减轻体重和降低心血管事件风险的功效。鉴于这些益处以及肾移植受者中常见的使用指征，GLP-1RA在该人群中的使用值得考虑。因此，我们试图回顾当前文献，以更好地了解GLP-1RA在肾移植受者中的作用机制、临床应用和以患者为中心的考虑因素。
2023年12月至2024年7月期间，通过电子数据库（包括Ovid MEDLINE数据库、PubMed和谷歌学术），使用“肾移植”“GLP-1”“胰高血糖素样肽-1受体激动剂”和“糖尿病”等术语，检索原始文章。
对文献进行全面综述，以探讨GLP-1RA与肾移植受者之间的关系。我们回顾了基础科学、临床和卫生服务研究以及以患者为中心的公平科学等研究领域的现有证据状态，并强调了为未来研究提供机会的重要知识空白。
众多临床研究已证明GLP-1RA对有或无糖尿病肾病患者有益，包括降低心血管事件风险。然而，分析GLP-1RA在肾移植受者中使用情况的高质量随机对照试验和观察性研究较少。因此，该人群的获益证据仅限于小型研究或从非移植人群的研究中推断得出。临床前和临床研究的证据不断增加，可能会阐明GLP-1RA的肾脏保护机制，并消除这些药物在移植受者人群中应用的障碍。女性、非白人、社会经济地位较低以及生活在农村社区的个体患糖尿病的风险更高，且GLP-1RA的使用率较低。需要针对不同肾移植人群开展临床试验，以评估GLP-1RA对重要健康结局的疗效。
本叙述性综述的检索策略可能对识别所有相关文章不够敏感。我们的检索仅限于英文文章。
