GLP-1RA have been associated with attenuating nephropathy in patients with T2D at high cardiovascular risk in recent cardiovascular safety studies with GLP-1RA. In addition to reducing renal risk factors, hypertension, obesity, blood pressure, and glycemia, GLP-1RA also have important actions in the kidney. The renal tubular effects of GLP-1RA are most prominent on natriuretic pathways and do not seem to extensively modify renal hemodynamics. A key mediator of this effect is likely the sodium-hydrogen ion exchanger (NHE3) in the renal proximal tubule, with other pathways such as inflammation and oxidative stress as potential renoprotective mechanisms. Given that these pathways are independent from SGLT-2i and RAS inhibitor targets in the kidney, GLP-1RA are likely to be complimentary for reducing nephropathy in type 2 diabetes. Primary dedicated renal protective trials with GLP-1RA are already planned and underway, and will ultimately determine the use of this drug class for renoprotection.
Renal Effects of GLP-1 Receptor Agonists: From Basic Mechanisms to Clinical Data
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