PDF(Pubmed)
Abstract：
Diabetic kidney disease (DKD) is a prevalent microvascular complication of diabetes, posing a significant health burden. Semaglutide, a glucagon-like peptide-1 receptor agonist, has shown promise in mitigating renal outcomes in DKD. This systematic review aimed to evaluate the renal effects of semaglutide in individuals with DKD. A comprehensive literature search identified six eligible studies, including two case reports and four cohorts, from diverse geographic locations. The primary outcomes assessed were changes in estimated glomerular filtration rate (eGFR) and albuminuria. Secondary outcomes included acute kidney injury (AKI) incidence and other renal biomarkers. The impact of semaglutide on eGFR was variable, with some studies reporting decreases and others showing improvements or no significant changes. Albuminuria, however, was more consistently reduced, particularly in patients with macroalbuminuria. Notably, the case reports described semaglutide-associated AKI, including acute interstitial nephritis, highlighting the need for careful monitoring during therapy. Beyond renal outcomes, semaglutide consistently improved glycemic control and promoted weight loss, with generally manageable gastrointestinal side effects. The findings suggest that semaglutide may effectively reduce albuminuria in DKD, potentially slowing disease progression. However, the risk of AKI and the variable impact on eGFR underscore the need for a personalized approach and vigilant monitoring, particularly in patients with advanced CKD. Future large-scale, long-term randomized controlled trials are warranted to definitively assess the renal benefits and risks of semaglutide in DKD.
摘要：
糖尿病肾病(DKD)是糖尿病常见的微血管并发症,造成了巨大的健康负担。塞马鲁肽,胰高血糖素样肽-1受体激动剂，在减轻DKD的肾脏结局方面显示出希望。本系统评价旨在评估司马鲁肽对DKD患者的肾脏影响。一项全面的文献检索确定了六项符合条件的研究，包括两个病例报告和四个队列，来自不同的地理位置。评估的主要结果是估计的肾小球滤过率（eGFR）和蛋白尿的变化。次要结果包括急性肾损伤（AKI）发生率和其他肾脏生物标志物。司马鲁肽对eGFR的影响是可变的，一些研究报告下降，另一些研究显示改善或没有显著变化。白蛋白尿,然而,更一致地减少，尤其是大量白蛋白尿患者。值得注意的是,病例报告描述了司马鲁肽相关的AKI，包括急性间质性肾炎,强调在治疗期间需要仔细监测。除了肾脏结果，司马鲁肽持续改善血糖控制并促进体重减轻,具有通常可控的胃肠道副作用。研究结果表明，司马鲁肽可以有效减少DKD的蛋白尿，可能减缓疾病进展。然而,AKI的风险和对eGFR的可变影响强调了个性化方法和警惕监测的必要性，尤其是晚期CKD患者。未来大规模，有必要进行长期随机对照试验,以明确评估司马鲁肽在DKD中的肾脏获益和风险.
