GLP-1 Receptor Agonists for Patients with Type 2 Diabetes and CKD

Introduction to GLP-1 RAs

• The American Diabetes Association and the National Kidney Foundation recommend prioritizing GLP-1 receptor agonists with proven cardiovascular and kidney benefits, such as liraglutide, semaglutide, and dulaglutide, for patients with type 2 diabetes and CKD 1, 2

Preferred Agents with Evidence

• Liraglutide demonstrated greater major adverse cardiovascular events (MACE) reduction in patients with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m² compared to those with higher eGFR 2
• Dulaglutide produced significantly slower glomerular filtration rate (GFR) decline compared to insulin glargine in patients with moderate-to-severe CKD (stages G3 and G4) 1

Kidney-Specific Benefits Demonstrated

• GLP-1 RAs with favorable outcomes reduced risk for composite kidney disease outcomes, including macroalbuminuria, eGFR decline, progression to kidney failure, and death from kidney disease 1, 2

Clinical Algorithm for Use

• If eGFR ≥30 ml/min/1.73 m², start with metformin and/or SGLT2i as first-line, according to the American College of Cardiology and American Heart Association guidelines 1, 2
• Choose liraglutide, semaglutide, or dulaglutide if glycemic targets are not met, as recommended by the European Association for the Study of Diabetes 1, 2

Special Considerations

• Heart rate typically increases by ~5 bpm with GLP-1 RA use, but has not been associated with adverse cardiovascular events, according to the American College of Cardiology 1, 2
• Semaglutide is available in oral formulation for patients who prefer non-injectable options, as noted by the National Institute of Diabetes and Digestive and Kidney Diseases 1, 2