Meta-analysis of the efficacy of glucagon-like peptide-1 receptor agonists in the treatment of diabetic nephropathy

Objective  To systematically evaluate the efficacy of glucagon-like peptide-1 receptor agonists（Glp-1 ras） in the treatment of Diabetic Kidney Disease（DKD）.

Methods  Foreign language databases such as Pub Med, EMbase and Cochrane Library, and Chinese databases such as Wanfang data, China National Knowledge Infrastructure Project, Chinese biomedical literature service system and VIP periodical resource integration service platform were searched. The quality of the included studies was assessed according to the quality assessment criteria of the Cochrane handbook, and the data were analyzed by Rev Man 5.3 software.

Results  Thirteen randomized controlled trials involving 1136 DKD patients were finally included. The results showed that the glucagon-like peptide-1 receptor agonist treatment group significantly improved 24-h urinary proteinMD=−13.44, 95%CI（−17.09, −9.79）, I²=5%, P＜0.00001, urinary albumin/creatinine ratioMD=−15.27, 95%CI（−17.12, −13.42）, I²=88%, P＜0.00001, blood-urea-nitrogenMD=−1.21, 95%CI（−1.41, −1.00）, I²=27%, P＜0.00001, glycosylated hemoglobinSMD=−1.12, 95%CI（−1.31, −0.94）, I²=38%, P＜0.00001, Serum creatinineMD=−7.55, 95%CI（−9.92, −5.17）, I²=19%, P＜0.00001, total serum cholesterolMD=−0.56, 95%CI（−0.70, −0.42）, I²=30%, P＜0.00001, and body mass indexMD=−3.61, 95%CI（−4.47, −2.76）, I²=0%, P＜0.00001, the differences were statistically significant.

Conclusion Glucagon-like peptide-1 receptor agonists have good efficacy in the treatment of diabetic nephropathy, with a significant effect on changing renal outcomes and improving metabolic levels, although higher quality evidence is needed for validation.