PDF(Pubmed)
Abstract：
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.
摘要：
背景和目的：关于胰高血糖素样肽-1受体激动剂（GLP-1RAs）在2型糖尿病（T2DM）合并晚期慢性肾脏病（CKD）或终末期肾脏病（ESKD）患者中的安全性和有效性的证据有限。因此，我们进行了系统评价和荟萃分析,以评估GLP-1RAs在T2DM合并晚期CKD和ESKD患者中的安全性和有效性.材料与方法：我们在MEDLINE进行了系统的文献检索，EMBASE,和Cochrane数据库，直到2023年10月25日。纳入的是临床试验和队列研究报告GLP-1RAs在T2DM和晚期CKD成年患者中的结果。结果指标包括死亡率，心血管参数,血糖，和重量。对不良事件进行安全性评估。效果差异表示为优势比，二分结果具有95％置信区间（CI），连续结果具有95％置信区间的加权平均差或标准化平均差（SMD）。非随机干预研究中的偏倚风险（ROBIN-I）工具用于队列和非随机对照研究，在随机对照试验(RCTs)中使用Cochrane偏差风险(RoB2)工具.审查方案已在国际前瞻性系统审查登记册（CRD42023398452）中注册，并且没有获得外部资金。结果：本荟萃分析纳入了由27,639名患者组成的8项研究（5项试验和3项队列研究）。一年死亡率没有差异。然而,GLP-1RA显着降低心胸比率（SMD为-1.2％；95％CI-2.0，-0.4）和pro-BNP（SMD-335.9pmol/L；95％CI-438.9，-232.8）。收缩压无明显下降。此外，GLP-1RA显着降低平均血糖（SMD-1.1mg/dL；95％CI-1.8，-0.3）并增加体重减轻（SMD-2.2kg；95％CI-2.9，-1.5）。在安全方面,GLP-1RA与恶心和呕吐的风险增加3.8倍和35.7倍相关。分别,但与低血糖的高风险并无显著相关.结论：尽管每次分析的研究数量有限，我们的研究提供了支持GLP-1RAs在患有晚期CKD和ESKD的T2DM患者中的安全性和有效性的证据.虽然可能会出现胃肠道副作用，GLP-1RA在血糖控制方面表现出显着改善，减轻体重,和心血管结局的潜在益处。
