Improving management of diabetic kidney disease: will GLP-1 receptor agonists have a role?

Kidney disease affects around 40% of people with type 2 diabetes and is a leading cause of morbidity and mortality. 1 Management of diabetic kidney disease has traditionally focused on tight glycaemic control (in the early stages) and blood pressure control (with agents that inhibit the renin–angiotensin system). 1 Despite this, most patients with diabetic kidney disease experience a gradual decline in kidney function, eventually progressing to end-stage kidney disease and an increased risk of cardiovascular events and mortality. Glucagon-like peptide-1 (GLP-1) receptor agonists are established treatments for type 2 diabetes that, in addition to lowering glucose, are associated with weight loss, lowering of blood pressure, and cardioprotection. 2 There is a lack of clarity, however, on the long-term benefits of GLP-1 receptor agonist therapy in patients with diabetic kidney disease, particularly in relation to glomerular function.