GLP-1 analogues in the management of nephropathy due to type 2 Diabetes Mellitus

Abstract

Objective: Evaluate the scientific evidence on the use of GLP-1 receptor agonists (GLP-1RAs) in the management of diabetic nephropathy (DN), with emphasis on mechanisms of action, renal and cardiovascular benefits, safety, and efficacy in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). Bibliographic review: DN is the leading cause of CKD, affecting 20–40% of individuals with T2DM and increasing the risk of cardiovascular events and progression to end-stage renal disease. Early diagnosis is based on the presence of albuminuria and the estimated glomerular filtration rate (eGFR). GLP-1 RAs promote nephroprotection through mechanisms such as natriuresis, albuminuria reduction, and endothelin-1 modulation. Clinical trials have shown reductions in CKD progression and cardiovascular events in these patients. They are indicated for patients with T2DM and CKD with eGFR >25 mL/min/1.73 m², also providing weight loss and a low risk of hypoglycemia. Adverse effects, mainly gastrointestinal, are common but manageable. Final considerations: GLP-1RAs represent a therapeutic innovation in ND, with proven efficacy and safety in the guidelines of the Brazilian Diabetes Society, the American Diabetes Association, and KDIGO. They point to more effective and integrated management, as well as new possibilities for clinical research.