Impact of GLP-1 receptor agonists on renal function and weight loss in patients with chronic kidney disease and obesity: a systematic review and meta-analysis

Background: Chronic kidney disease (CKD) and obesity are major public health concerns with significant socioeconomic implications. While Glucagon-like peptide-1 receptor agonists (GLP-1) can be effective for glycaemic control and weight loss, their impact on renal outcomes remains unclear. Objectives: To perform a systematic review and meta-analysis of randomized clinical trials to evaluate the impact and the safety profile of GLP-1 on renal function and weight loss in patients with CKD and obesity. Results: Six RCTs, with a total of 8.111 patients with CKD, overweight or obesity and with or without diabetes were included. At 26 weeks, treatment wih GLP-1 agonists were associated with decreased UACR (MD = −24.01%; 95% CI: −36.11 to −11.91, p = 0.0001; I² = 74.3%) and bodyweight (MD = −3.23 kg; 95% CI: −5.22 to −1.25, p = 0.0014; I² = 0%) compared to control groups. No significant difference in eGFR change was observed between GLP-1 agonists and control groups (MD = 0.62 mL/min/1.73m2; 95% CI: –1.66 to 2.89, p = 0.35; I² = 94%). Moderate to substantial heterogeneity was observed for UACR and eGFR outcomes (I² = 74.3% and 94%, respectively), suggesting variability in treatment effects across studies. No significant difference in the risk of acute kidney injury between GLP-1 and placebo groups was observed (OR = 0.94; 95% CI, 0.78 to 1.13; p = 0.4268). Conclusions: GLP-1 agonists were associated with significant weight loss and reduction of UACR in patients with CKD and overweight or obesity. No significant effect was observed on eGFR. GLP-1 receptor agonists do not appear to increase the risk of renal adverse events in patients with CKD and overweight or obesity. Further long-term studies focusing on renal outcomes are needed to clarify their role in preserving kidney function.