Table 1: Summary of clinical trials evaluating the use of GLP-1 agonists to treat diabetes in patients with CKD.
Drug/Trial | Baseline mean GFR (SD) mL/min/1.73 m2 | Baseline median UACR mg/g | Baseline mean A1C % | Composite Kidney Outcome | GFR Change | UACR Change | Body weight change |
Liraglutide LEADER [9]
|
80 20.7% GFR 30-59 2.4% GFR < 30 |
26.3% had macroalbuminuria 10.5% had microalbuminuria
|
8.7
|
22% reduction
|
-7.44/36 months
|
17% reduction 26% reduction in new onset macroalbuminuria
|
-2.3 kg
|
Liraglutide LIRA-RENAL [11] | 45.4 ± 0.23
43.6% GFR 30-45 55.7% GFR 45-59 |
55.5 ± 7.58 | 8.1 ± 0.8 | No composite | -0.35/26 weeks | 13% reduction | -2.4 kg |
Dulaglutide Tuttle 2017 [13] | 89.4 ± 17.1 | 8.9 (4.4-23.9) | 7.6-8.5 across 9 studies | No composite | No significant change in GFR | -16.7% vs. -10.0% for placebo
-20.0% vs. -12.5% for active comparator -20.0% vs. -9.4% for insulin glargine. |
Not reported |
Dulaglutide AWARD7 Abstract ADA 2017 [14] | 38.3 ± 12.8 | 200 | 8.6 | No composite for kidney events | -0.4 for 0.75 mg dose -0.1 for 1.5 mg dose
-1.9 for insulin glargine |
-26.7% for 0.75 mg -27.7% for 1.5 mg
-16.4% in insulin glargine |
-2.8 kg |
EXSCEL Exenatide ER [15] | 29.0% GFR > 90
49.7% GFR 60-89 21.2% GFR 30-59 0.1% GFR < 30 |
Not reported | 8.0 | No composite for kidney events | Percentage of patients discontinuing due to eGFR < 30 mL/min/1.73 m2
1.1% vs. 1.3% placebo ESRD 0.7 versus 0.9% in placebo |
Microalbuminuria 7.2 versus 7.5% in placebo
Macroalbuminuria 2.2 versus 2.8% in placebo |
-1.27 kg |
GFR: Glomerular Filtration Rate; UACR: Urinary Albumin to Creatinine Ratio; kg: Kilogram; ADA: American Diabetes Association; ER: Extended Release.