GLP-1 agonists cut the composite kidney outcome by a fifth in type 2 diabetes, across 20 trials and 83,000 patients

The edition in brief

A meta-analysis of 20 placebo-controlled trials in 83,004 people with type 2 diabetes found GLP-1 receptor agonists reduced a composite kidney outcome by 20% (RR 0.80, 0.73-0.88), major cardiovascular events by 13% and all-cause death by 11%, with heart failure admissions not significantly reduced. In the phase 2 Explore-CKD crossover trial, 59 adults with uncontrolled hypertension, CKD and albuminuria already on RAS blockade and an SGLT2 inhibitor had a placebo-adjusted fall of 7.5 mmHg in office systolic pressure and 25.6% in albuminuria over four weeks with the aldosterone synthase inhibitor lorundrostat, with an early eGFR dip and three discontinuations for adverse events. A Kidney International review of congenital anomalies of the kidney and urinary tract notes a genetic cause in about a fifth, kidney replacement therapy starting at a mean age of about 31, and raised cardiovascular, metabolic and neurocognitive risk, arguing for life-course care. In a Turkish crossover trial of 32 haemodialysis patients, eating during dialysis did not change Kt/V, urea reduction ratio or fatigue but was associated with larger intradialytic blood pressure falls.