Kidney Week Early 2025 Program - Diabetes Management for the Nephrology Care Team: New Technology and New Drugs-How to Use Incretin Mimetics in Nephrology Clinic

Video Transcription

Video Summary

Daniel van Raalte, an endocrinologist, internist, and vascular medicine specialist at Amsterdam University Medical Center, outlines how incretin therapies—especially GLP-1 receptor agonists—fit into kidney care. He reviews the evolution from short-acting, DPP-4–resistant agents to long-acting weekly formulations (and future monthly options), and highlights newer dual agonists such as tirzepatide (GIP/GLP-1). He emphasizes key benefits relevant to nephrology patients: substantial weight loss driven largely by central satiety pathways, proven cardiovascular risk reduction, and emerging evidence of kidney protection (e.g., the FLOW trial with semaglutide), including effects beyond glucose lowering. Mechanisms remain uncertain, with hypotheses involving hemodynamics, inflammation, oxidative stress, metabolism, and sodium handling; ongoing mechanistic trials using advanced imaging and kidney biopsies aim to clarify this. Practical prescribing focuses on slow titration and side-effect management, particularly GI symptoms, plus careful down-titration of other diabetes and blood pressure drugs. He concludes that benefits typically outweigh risks and that more potent multi-agonists and amylin-based therapies are coming.

Asset Subtitle

Daniël van Raalte

Meta Tag

Module DKD

Speaker Daniël van Raalte

Keywords

incretin therapies

GLP-1 receptor agonists

chronic kidney disease nephrology

tirzepatide dual GIP GLP-1 agonist

FLOW trial semaglutide kidney outcomes

cardiovascular risk reduction weight loss