Kidney Week Educational Symposia-Glucagon-Like Peptide-1 Receptor Agonists Are Becoming Important Players in Diabetic Kidney Disease

Video Transcription

Video Summary

The symposium reviewed growing evidence that glucagon-like peptide-1 receptor agonists (GLP-1 RAs) provide kidney protection in diabetes, alongside major cardiovascular benefits. Speakers emphasized the large and rising global burden of diabetes and diabetic kidney disease (DKD), noting that kidney failure outcomes have improved less than other diabetic complications and that most excess mortality in diabetes is driven by kidney disease (albuminuria and reduced eGFR) through cardiovascular mechanisms.<br /><br />Dr. Katrin Tuttle summarized data from cardiovascular outcome trials and CKD-focused studies showing GLP-1 RAs reduce albuminuria and slow eGFR decline, with notable effects in patients with eGFR 30–60. AWARD-7 (dulaglutide vs insulin) demonstrated eGFR stabilization and fewer kidney events despite similar glycemic control, suggesting benefits beyond glucose lowering, potentially via anti-inflammatory, anti-oxidative, and anti-fibrotic pathways. She highlighted emerging dual incretin therapy (GLP-1/GIP, e.g., tirzepatide) showing strong reductions in albuminuria and slower eGFR decline in trials like SURPASS-4.<br /><br />Dr. Silvia Rosas reviewed key trial evidence (e.g., LEADER, SUSTAIN-6/PIONEER-6) and real-world registry data supporting renal benefit, while noting that many kidney outcomes in CV trials are driven by albuminuria due to short follow-up and low baseline CKD prevalence. She outlined guideline-directed therapy (ADA/KDIGO): lifestyle, RAS blockade, SGLT2 inhibitors, finerenone, and GLP-1 RAs—anticipating stronger kidney indications pending FLOW trial results.<br /><br />The FLOW semaglutide kidney outcomes trial was stopped early for efficacy, raising expectations of definitive renal outcome benefit. Discussion stressed team-based prescribing, overcoming therapeutic inertia, managing GI side effects (“start low, go slow,” switch agents), and future evidence in non-diabetic CKD and type 1 diabetes.

Asset Subtitle

Moderator(s): Monika Niewczas

Presentation(s):

Introduction - Monika Niewczas
GLP1 RAs and Kidney Outcomes in Diabetes - Katherine Tuttle
GLP1 RAs as a Part of the Diabetic Kidney Disease Therapeutic Landscape - Sylvia Rosas

Support is provided by an educational grant from Novo Nordisk.

Meta Tag

Date 11/4/2023

Pathway 1 Diabetic Kidney Disease

Pathway 2 CKD Non-Dialysis

Session ID 468533

Session Type ES - Educational Symposium

Keywords

GLP-1 receptor agonists

diabetic kidney disease

kidney protection

albuminuria reduction

eGFR decline slowing

cardiovascular outcome trials

AWARD-7 dulaglutide

tirzepatide dual incretin GLP-1/GIP

ADA KDIGO guidelines

FLOW semaglutide trial