PMID- 38248365 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20240128 IS - 2079-9721 (Print) IS - 2079-9721 (Electronic) IS - 2079-9721 (Linking) VI - 12 IP - 1 DP - 2024 Jan 2 TI - Safety and Efficacy of GLP-1 Receptor Agonists in Type 2 Diabetes Mellitus with Advanced and End-Stage Kidney Disease: A Systematic Review and Meta-Analysis. LID - 10.3390/diseases12010014 [doi] LID - 14 AB - Background and Objectives: Limited evidence exists regarding the safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 2 diabetes mellitus (T2DM) patients with advanced chronic kidney disease (CKD) or end-stage kidney disease (ESKD). Thus, we conducted a systematic review and meta-analysis to assess the safety and efficacy of GLP-1RAs in T2DM patients with advanced CKD and ESKD. Materials and Methods: We performed a systematic literature search in MEDLINE, EMBASE, and Cochrane database until 25 October 2023. Included were clinical trials and cohort studies reporting outcomes of GLP-1RAs in adult patients with T2DM and advanced CKD. Outcome measures encompassed mortality, cardiovascular parameters, blood glucose, and weight. Safety was assessed for adverse events. The differences in effects were expressed as odds ratios with 95% confidence intervals (CIs) for dichotomous outcomes and the weighted mean difference or standardized mean difference (SMD) with 95% confidence intervals for continuous outcomes. The Risk of Bias In Non-randomized Studies-of Interventions (ROBIN-I) tool was used in cohort and non-randomized controlled studies, and the Cochrane Risk of Bias (RoB 2) tool was used in randomized controlled trials (RCTs). The review protocol was registered in the International Prospective Register of Systematic Reviews (CRD 42023398452) and received no external funding. Results: Eight studies (five trials and three cohort studies) consisting of 27,639 patients were included in this meta-analysis. No difference was observed in one-year mortality. However, GLP-1RAs significantly reduced cardiothoracic ratio (SMD of -1.2%; 95% CI -2.0, -0.4) and pro-BNP (SMD -335.9 pmol/L; 95% CI -438.9, -232.8). There was no significant decrease in systolic blood pressure. Moreover, GLP-1RAs significantly reduced mean blood glucose (SMD -1.1 mg/dL; 95% CI -1.8, -0.3) and increased weight loss (SMD -2.2 kg; 95% CI -2.9, -1.5). In terms of safety, GLP-1RAs were associated with a 3.8- and 35.7-time higher risk of nausea and vomiting, respectively, but were not significantly associated with a higher risk of hypoglycemia. Conclusions: Despite the limited number of studies in each analysis, our study provides evidence supporting the safety and efficacy of GLP-1RAs among T2DM patients with advanced CKD and ESKD. While gastrointestinal side effects may occur, GLP-1RAs demonstrate significant improvements in blood glucose control, weight reduction, and potential benefit in cardiovascular outcomes. FAU - Krisanapan, Pajaree AU - Krisanapan P AUID- ORCID: 0000-0002-2888-881X AD - Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. AD - Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand. AD - Division of Nephrology, Department of Internal Medicine, Thammasat University Hospital, Pathum Thani 12120, Thailand. FAU - Sanpawithayakul, Kanokporn AU - Sanpawithayakul K AD - Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand. AD - Department of Clinical Epidemiology, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand. FAU - Pattharanitima, Pattharawin AU - Pattharanitima P AD - Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12120, Thailand. FAU - Thongprayoon, Charat AU - Thongprayoon C AD - Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. FAU - Miao, Jing AU - Miao J AUID- ORCID: 0000-0003-0642-9740 AD - Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. FAU - Mao, Michael A AU - Mao MA AUID- ORCID: 0000-0003-1814-7003 AD - Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA. FAU - Suppadungsuk, Supawadee AU - Suppadungsuk S AD - Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. AD - Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand. FAU - Tangpanithandee, Supawit AU - Tangpanithandee S AD - Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand. FAU - Craici, Iasmina M AU - Craici IM AD - Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. FAU - Cheungpasitporn, Wisit AU - Cheungpasitporn W AUID- ORCID: 0000-0001-9954-9711 AD - Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. LA - eng PT - Journal Article PT - Review DEP - 20240102 PL - Switzerland TA - Diseases JT - Diseases (Basel, Switzerland) JID - 101636232 PMC - PMC10814593 OTO - NOTNLM OT - CKD stage5 OT - DM OT - ESKD OT - GLP-1RAs OT - T2DM OT - advanced CKD OT - diabetes mellitus OT - dulaglutide OT - end-stage kidney disease OT - glucagon-like peptide-1 receptor agonist OT - liraglutide OT - lixisenatide COIS- The authors declare no conflicts. EDAT- 2024/01/22 06:42 MHDA- 2024/01/22 06:43 PMCR- 2024/01/02 CRDT- 2024/01/22 04:37 PHST- 2023/11/17 00:00 [received] PHST- 2023/12/27 00:00 [revised] PHST- 2023/12/27 00:00 [accepted] PHST- 2024/01/22 06:43 [medline] PHST- 2024/01/22 06:42 [pubmed] PHST- 2024/01/22 04:37 [entrez] PHST- 2024/01/02 00:00 [pmc-release] AID - diseases12010014 [pii] AID - diseases-12-00014 [pii] AID - 10.3390/diseases12010014 [doi] PST - epublish SO - Diseases. 2024 Jan 2;12(1):14. doi: 10.3390/diseases12010014.