Obesity and Diabetes Drugs Could Help To Protect the Kidneys

New research from The George Institute of Global Health shows that a popular class of obesity and type 2 diabetes drugs can reduce a person’s risk of kidney deterioration and failure regardless of whether they have type 2 diabetes or not.

The study, which could have a particular impact for those with chronic kidney disease (CKD), was published in The Lancet Diabetes & Endocrinology.

Expanding the list of indications for GLP-1 receptor agonists?

CKD is estimated to affect 850 million people worldwide. It one of the leading causes of death globally, and is projected to become the fifth most common cause of death by 2050. 

The popular group of diabetes and weight loss drugs, glucagon-like peptide 1 (GLP-1) receptor agonists, have made headlines for their effects on type 2 diabetes, obesity and cardiovascular disease. Given that diabetes is a risk factor for CKD, the George Institute researchers wondered whether the GLP-1 drugs could also benefit people help prevent the kidney disease.

“The results of a previous study published in 2021 suggested that GLP-1 receptor agonists may improve kidney disease outcomes in people with type 2 diabetes,” Sunil Badve, professorial fellow at The George Institute for Global Health, told Technology Networks.

However, the kidney disease outcome evaluated in that study was not validated for kidney failure (also known as end-stage kidney disease), which is the most important kidney disease outcome. The path from kidney disease to kidney failure often requires kidney replacement therapy such as dialysis or transplantation and can even cause death.

“Therefore, we hypothesized that GLP-1 receptor agonists improve important kidney and cardiovascular outcomes in people at high-risk for kidney disease progression and/or cardiovascular disease.”

Meta-analysis shows promise for CKD

The new meta-analysis examined data from 11 trials involving over 85,000 participants, of whom ~67,000 had type 2 diabetes and ~17,000 had no history of diabetes.

They looked at the effects of seven different GLP-1 receptor agonist drugs, most notably semaglutide (also known as Ozempic® or Wegovy®) and liraglutide (Victoza®).

The findings revealed that GLP-1 receptor agonists cut the risk of kidney failure by 16% and the worsening of kidney function by 22% compared to placebo for people both with and without type 2 diabetes.

“This is the first GLP-1 receptor agonist study to show significant reduction in the risk of kidney failure. While the heart-protective benefits of GLP-1 receptor agonists were already known, our study establishes GLP-1 receptor agonists as an important kidney-protective class of medications.”

“In our study, GLP-1 receptor agonists also reduced the risk of death due to a cardiovascular cause and also death due to any cause,” said Badve.

Compared to placebo, there was a 14% reduction in risk of cardiovascular death, non-fatal heart attack and non-fatal stroke, alongside a 13% lower risk of death by any cause for those taking GLP-1 receptor agonists.

“GLP-1 receptor agonists not only lower blood glucose levels and body weight, but they also have kidney-protective and heart-protective benefits and save lives,” Badve explained. “These agents could play an important role in the management of patients at high risk for kidney disease progression and cardiovascular events.”

“More studies are needed in high-risk individuals with high-risk kidney disease and/or cardiovascular disease but without type 2 diabetes as well as in individuals with type 1 diabetes,” he said.

Reference: Badve SV, Bilal A, Lee MMY, et al. Effects of GLP-1 receptor agonists on kidney and cardiovascular disease outcomes: a meta-analysis of randomised controlled trials. Lancet Diabetes Endocrinol. 2024;0(0). doi: 10.1016/S2213-8587(24)00271-7

About the interviewee:

Sunil Badve is a senior staff specialist in nephrology at St George Hospital, Sydney and professorial fellow at The George Institute for Global Health. He has been practising as a consultant nephrologist in Australia since 2009 and was awarded a PhD from the University of Queensland in 2016. His research focuses on randomized controlled trials, meta-analyses and epidemiology, with particular focus on chronic kidney disease and cardiovascular disease.