Real-world data suggest that glucagon-like peptide-1 receptor agonists (GLP-1 RA) may help protect kidney health in people with type 2 diabetes (T2D). However, compared to sodium-glucose cotransporter-2 inhibitors (SGLT2i), GLP-1 RAs may not offer the same level of kidney protection, particularly when it comes to acute kidney injury (AKI) and reduction in kidney function. The findings were published in the Diabetes/Metabolism Research and Reviews.

Researchers systematically reviewed 31 observational cohort studies published between 2005 and 2025, with over 1.6 million patients with T2D. These studies compared the effects of initiating GLP-1 RA therapy with those of SGLT2i, dipeptidyl-peptidase 4 inhibitors (DPP4i), basal insulin, or sulfonylureas on several adverse kidney outcomes. The outcomes included albuminuria progression, a 40% or 50% reduction in estimated glomerular filtration rate (eGFR), AKI, kidney-related hospitalizations, and end-stage kidney disease (ESKD).

Compared to SGLT2 inhibitors, patients on GLP-1 RAs showed significantly higher risks for AKI (HR 1.12), kidney-related hospitalizations (HR 1.66), and ≥40% eGFR decline (HR 1.40). There were no significant differences in the risk of ESKD or ≥50% eGFR decline between the two drug classes.

On the other hand, when compared to DPP4 inhibitors, GLP-1 RAs were associated with a lower risk of major kidney events. Patients initiating GLP-1 RAs had a reduced risk of ≥50% eGFR decline (HR 0.84), kidney-related hospitalizations (HR 0.73), and ESKD (HR 0.70). Similar kidney benefits were also seen in comparisons with sulfonylureas. When compared to basal insulin, GLP-1 RAs were linked to a lower risk of albuminuria progression (HR 0.89).