GLP-1 RAs and SGLT-2i's may help slow kidney damage

GLP-1 receptor agonists and SGLT-2 inhibitors may help to slow decline in kidney function in people with type 2 diabetes and albuminuria, a large US study published this week in The BMJ has concluded.

However, for those without albuminuria, little evidence of benefit was seen, and other diabetes drugs such as sulfonylureas accelerated decline in kidney function, highlighting the importance of considering albuminuria when making treatment decisions, the authors said.

Previous studies have shown that GLP-1 receptor agonists and SGLT-2 inhibitors can lower the risk of chronic kidney disease (CKD) progression in people with type 2 diabetes, and suggest that this may be more pronounced among those with greater degrees of albuminuria.

But it’s not known whether people without albuminuria taking these drugs experience a similar degree of protection from CKD.

To address this, researchers analysed health records and insurance claims data for people with type 2 diabetes at moderate risk of cardiovascular disease who started treatment with a GLP-1 receptor agonist or SGLT-2 inhibitor, a sulfonylurea, or a dipeptidyl peptidase-4 (DPP-4) inhibitor after metformin treatment between 2014 and 2022.

A total of 75,455 individuals were included in the analysis of whom 61,583 (82%) did not have albuminuria. They were monitored for an average of 32 months, during which time decline in kidney function was assessed using recognised blood tests.

For people with albuminuria, the estimated 5-year risk of decline in kidney function was 3.2% for GLP-1 receptor agonists or SGLT-2 inhibitors, 4.6% for sulfonylureas, and 5.4% for DPP-4 inhibitors. This represents a 40% lower risk of renal deterioration among people treated with GLP-1 receptor agonists or SGLT-2 inhibitors compared with DPP4 inhibitors.

For people without albuminuria, the estimated 5-year risk of decline in kidney function was 2.4% for GLP-1 receptor agonists or SGLT-2 inhibitors, 2.8% for sulfonylureas, and 2.1% for DPP-4 inhibitors. This represents a 31% increased risk of renal deterioration among people treated with sulfonylureas compared with DPP4 inhibitors.

The authors concluded: ‘Compared with DPP-4 inhibitors, GLP-1 receptor agonists and SGLT-2 inhibitors reduce the risk of deterioration of renal function in people with albuminuria, [but there was] little evidence of renal benefit among people without albuminuria over the study follow-up period.’

Take home points

• In people with type 2 diabetes and albuminuria, GLP-1 receptor agonists and SGLT-2 inhibitors had renoprotective effects
• In people with type 2 diabetes and normoalbuminuria, sulfonylureas led to faster renal function decline
• These results underline the importance of considering albuminuria when making treatment decisions for people with type 2 diabetes at risk of declining renal function.

Turchin A, et al. BMJ 2026;394:e100574