Editorial
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Sep 15, 2020; 11(9): 370-373
Published online Sep 15, 2020. doi: 10.4239/wjd.v11.i9.370
Is there a role for glucagon-like peptide-1 receptor agonists in the management of diabetic nephropathy?
Stavroula Veneti, Konstantinos Tziomalos
Stavroula Veneti, Konstantinos Tziomalos, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki 54636, Greece
Author contributions: Veneti S drafted the editorial; and Tziomalos K critically revised the draft.
Conflict-of-interest statement: None of the authors has any conflict of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Konstantinos Tziomalos, MD, MSc, PhD, Associate Professor, First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA Hospital, 1 Stilponos Kyriakidi Street, Thessaloniki 54636, Greece. ktziomalos@yahoo.com
Received: July 5, 2020
Peer-review started: July 5, 2020
First decision: July 30, 2020
Revised: August 2, 2020
Accepted: September 3, 2020
Article in press: September 3, 2020
Published online: September 15, 2020
Processing time: 68 Days and 0.8 Hours
Abstract

Chronic kidney disease constitutes a major microvascular complication of diabetes mellitus. Accumulating data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) might have a role in the management of diabetic kidney disease (DKD). GLP-1 RAs appear to reduce the incidence of persistent macro-albuminuria in patients with type 2 diabetes mellitus. This beneficial effect appears to be mediated not only by the glucose-lowering action of these agents but also on their blood pressure lowering, anti-inflammatory and antioxidant effects. On the other hand, GLP-1 RAs do not appear to affect the rate of decline of glomerular filtration rate. However, this might be due to the relatively short duration of the trials that evaluated their effects on DKD. Moreover, these trials were not designed nor powered to assess renal outcomes. Given than macrolbuminuria is a strong risk factor for the progression of DKD, it might be expected that GLP-1 RAs will prevent the deterioration in renal function in the long term. Nevertheless, this remains to be shown in appropriately designed randomized controlled trials in patients with DKD.

Keywords: Diabetic nephropathy; Type 2 diabetes mellitus; Glucagon-like peptide-1 receptor agonists; Liraglutide; Dulaglutide; Semaglutide

Core Tip: Glucagon-like peptide-1 receptor agonists prevent the development of persistent macroalbuminuria in patients with type 2 diabetes mellitus. However, it is unclear whether they delay the decline in glomerular filtration rate in this population. Long-term trials are needed to clarify the role of these agents in the management of diabetic nephropathy.