Resumen
Objetivo: Analizar los efectos de los análogos de GLP-1 sobre la progresión de la enfermedad renal crónica (ERC) en pacientes con diabetes tipo 2, sus beneficios y riesgos asociados a su uso. Métodos: Revisión bibliográfica integrativa en la base de datos PubMed Central (PMC), utilizando la estrategia de búsqueda: ((GLP-1RA) OR (Glucagon-like peptid-1 receptor agonists) OR (GLP-1)) AND ((Chronic Kidney Disease) OR (CKD)) en el período de 2019 a 2024. Luego de la búsqueda inicial, se identificaron 585 estudios que fueron sometidos a criterios de selección. Luego de aplicar criterios de inclusión y exclusión, fueron seleccionados 18 artículos para componer este estudio. Resultados: Se analizó el impacto de los análogos de GLP-1 sobre la función renal y la progresión de la ERC en pacientes con diabetes tipo 2, explorando los mecanismos de protección renal, evaluando riesgos potenciales en diferentes etapas de la enfermedad. Consideraciones finales: Los estudios sugieren una reducción de la albuminuria y un retraso en la caída de la Tasa de Filtración Glomerular (TFG), promoviendo así un pronóstico más favorable. El uso de análogos de GLP-1 en pacientes con ERC es beneficioso en la protección renal, sin embargo, aún requiere especial atención en estadios avanzados de la enfermedad para evitar posibles complicaciones.
Referencias
ALICIC RZ e NEUMILLER JJ. Incretin Therapies for Patients with Type 2 Diabetes and Chronic Kidney Disease. Journal Clinical Medicine, 2023; 13(1): 201.
BHAILÍS ÁM, et al. Diabetic kidney disease: update on clinical management and non-glycaemic effects of newer medications for type 2 diabetes. Therapeutic Advances in Endocrinology and Metabolism, 2021; 12: 1-15.
BOMHOL T, et al. The Glycemic Effect of Liraglutide Evaluated by Continuous Glucose Monitoring in Persons with Type 2 Diabetes Receiving Dialysis. Nephron, 2021; 145(1): 27-34.
BUENO BA, et al. Semaglutide in type 2 diabetes with chronic kidney disease at high risk of progression—real-world clinical practice. Clinical Kidney Journal, 2022; 15(8): 1593–1600.
CHEN JJ, et al. Association of Glucagon-Like Peptide-1 Receptor Agonist vs Dipeptidyl Peptidase-4 Inhibitor: Use With Mortality Among Patients With Type 2 Diabetes and Advanced Chronic Kidney Disease. JAMA Network Open, 2022; 5(3): 221169-221169.
COLHOUN HM, et al. Long-term kidney outcomes of semaglutide in obesity and cardiovascular disease in the SELECT trial. Nature Medicine, 2024; 30: 2058-2066.
DE LUCAS MDG, et al. Influence of chronic kidney disease and its severity on the efficacy of semaglutide in type 2 diabetes patients: a multicenter real-world study. Frontiers in Endocrinology, 2023; 14: 1240279.
GARCIA LP, et al. Progress in the management of patients with diabetes and chronic kidney disease. Current Opinion in Nephrology and Hypertension, 2022; 31(5): 456-463.
KRISANAPAN P, et al. Safety and efficacy of GLP-1 receptor agonists in type 2 diabetes mellitus with advanced and end-stage kidney disease: a systematic review and meta-analysis. Diseases, 2024; 12(1): 14.
LI X, et al. Effect of glucagon-like peptide 1 receptor agonists on the renal protection in patients with type 2 diabetes: a systematic review and meta-analysis. Diabetes & Metabolism, 2022; 48(5): 101366.
LI Y, et al. Comparison of efficacy and safety of three novel hypoglycemic agents in patients with severe diabetic kidney disease: A systematic review and network meta-analysis of randomized controlled trials. Frontiers in Endocrinology, 2022; 13: 1003263.
MANN JFE, et al. Potential Kidney protection with liraglutide and semaglutide: exploratory mediation analysis. Diabetes, Obesity and Metabolism, 2021; 23(9): 2058-2066.
MAYNE KJ, et al. Detecting and managing the patient with chronic kidney disease in primary care: A review of the latest guidelines. Diabetes, Obesity and Metabolism, 2024; 1(1): 1-12.
SCHECHTER M, et al. Kidney function loss and albuminuria progression with GLP-1 receptor agonists versus basal insulin in patients with type 2 diabete: real-world evidence. Cardiovascular Diabetology, 2023; 22(1): 126.
SCHOLTEN BJV, et al. The potential of GLP-1 receptor agonists in type 2 diabetes and chronic disease: from randomised trials to clinical pratice. Therapeutic Advances in Endocrinology and Metabolism, 2022; 13: 1-14.
SHAMAN AM, et al. Effect of the Glucagon-Like Peptide-1 Receptor Agonists Semaglutide and Liraglutide on Kidney Outcomes in Patients With Type 2 Diabetes: Pooled Analysis of SUSTAIN 6 and LEADER. Circulation, 2022; 145(8): 575-585.
SLOAN LA. Review of glucagon‐like peptide‐1 receptor agonists for the treatment of type 2 diabetes mellitus in patients with chronic kidney disease and their renal effects. Journal of Diabetes, 2019; 11(12): 938-948.
SUZUKI Y, et al. Comparison of estimated glomerular filtration rate change with sodium-glucose cotransporter-2 inhibitors versus glucagon-like peptide-1 receptor agonists among people with diabetes: A propensity-score matching study. Diabetes, Obesity and Metabolism, 2024; 26(6): 2422-2430.
TREVELLA P, et al. Potential kidney protective effects of glucagon‐like peptide‐1 receptor agonists. Nephrology, 2024; 29: 457-469.
TUTTLE KR, et al. Effects of Once-Weekly Semaglutide on Kidney Disease Outcomes by KDIGO Risk Category in the SUSTAIN 6 Trial. Kidney International Reports, 2024; 9: 2006-2015.
WALGORZATA M e NOWICKI M. The impact of GLP‑1 receptor agonist liraglutide on blood pressure profle, hydration, natriuresis in diabetic patients with severely impaired kidney function. Scientific reports, 2024; 14(1): 5002.
WILLIAMS DM e EVANS M. Semaglutide: Charting New Horizons in GLP-1 Analogue Outcome Studies. Diabetes Therapy, 2020; 11(10): 2221-2235.
ZHAO JZ, et al. Hypoglycemia risk with SGLT2 inhibitors or glucagon-like peptide 1 receptor agonists versus sulfonylureas among medicare insured adults with CKD in the United States. Kidney Medicine, 2022; 4(8): 100510.
