■心血管结局试验表明胰高血糖素样肽-1受体激动剂(GLP-1RAs)对肾脏有益;然而,在糖尿病肾病(DKD)的实际疗效和安全性研究很少.
■这次回顾展,单臂真实世界试验包括接受GLP-1RA治疗至少6个月的DKD成人.主要终点是6个月后的血红蛋白A1c(HbA1c)水平。
■本研究共纳入364名DKD患者,其中153人(42.0%)为女性。中位病程为8.0年,和年龄的平均值,HbA1c水平,身体质量指数,尿白蛋白肌酐比值(UACR)为52.1年,8.6%,27.8kg/m2,88.0mg/g,分别。此外,73.6%和26.4%的患者患有轻度和中度DKD,分别。GLP-1RA治疗6个月后,平均HbA1c水平和UACR下降了1.77%和40.3%,分别(均p<0.001)。与它们的基线值相比,患者24小时尿蛋白显着改善,估计肾小球滤过率(eGFR),空腹血糖,体重,收缩压(SBP),舒张压(DBP),总胆固醇,甘油三酯,高密度脂蛋白胆固醇,和低密度脂蛋白胆固醇(均p<0.001)。病程<10年的患者HbA1c水平有更明显的变化,UACR,和eGFR(所有p<0.001)比那些病程≥10年的患者。同时服用血管紧张素转换酶抑制剂/血管紧张素II受体阻滞剂(ACEis/ARBs)的患者SBP和DBP的变化比不服用ACEis/ARBs的患者更明显,而UACR和eGFR的变化没有显著差异.
■6个月GLP-1RA治疗可改善血糖,血压,脂质,轻度至中度DKD患者的体重,同时减缓肾脏疾病的进展。它独立地减少蛋白尿超过ACEi/ARB的影响,早期使用会产生更快的结果,支持循证实践。
UNASSIGNED: Cardiovascular outcome trials indicate renal benefits of glucagon-like peptide-1 receptor agonists (GLP-1RAs); however, real-world efficacy and safety studies in Diabetic kidney disease (DKD) are scarce.
UNASSIGNED: This retrospective, single-arm real-world trial involved adults with DKD treated with GLP-1RA for at least 6 months. The primary endpoint was hemoglobin A1c (HbA1c) levels after 6 months.
UNASSIGNED: This study included a total of 364 patients with DKD, 153 (42.0%) of whom were female. The median disease duration was 8.0 years, and the mean values of age, HbA1c level, body mass index, and the urinary albumin-to-creatinine ratio (UACR) were 52.1 years, 8.6%, 27.8 kg/m2, and 88.0 mg/g, respectively. Additionally, 73.6% and 26.4% of patients had mild and moderate DKD, respectively. Following 6 months of GLP-1RA treatment, the mean HbA1c level and UACR declined by 1.77% and 40.3%, respectively (both p < 0.001). Compared to their baseline values, patients exhibited significant improvements in 24-h urinary protein, estimated glomerular filtration rate (eGFR), fasting blood glucose, body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol (all p < 0.001). Patients with a disease duration of <10 years had more pronounced changes in the HbA1c level, UACR, and eGFR (all p < 0.001) than those with a disease duration of ≥10 years. Changes in SBP and DBP were more pronounced in patients also taking angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEis/ARBs) than in those not taking ACEis/ARBs, whereas the changes in UACR and eGFR did not significantly differ.
UNASSIGNED: Six-month GLP-1RA treatment improves glucose, blood pressure, lipids, and body weight in patients with mild-to-moderate DKD while slowing down kidney disease progression. It independently reduces proteinuria beyond ACEi/ARB impact, with early use yielding faster outcomes, supporting evidence-based practice.