Efficacy and Safety of GLP ‐1 Receptor Agonists on Combined Cardiovascular and Renal Outcomes in Patients With Chronic Kidney Disease: A Systematic Review and Meta‐Analysis
Authors' conclusion
GLP-1 RAs provide clinically meaningful cardiorenal protection in CKD, additive to SGLT2 inhibitor benefits. In exploratory network meta-analysis, semaglutide subcutaneous achieved the highest SUCRA ranking for kidney composite outcomes; the direct semaglutide evidence is rated high certainty by GRADE.
Study context
- Population
- Adults with chronic kidney disease (CKD) (eGFR < 60 mL/min/1.73 m² or UACR ≥ 30 mg/g) in RCTs of ≥ 26 weeks; searches through March 2025
- Participants
- 97,428 adults13 RCTs
- Comparison
- GLP-1 RA vs placebo
- Outcome
- 3-point MACE and a KDIGO-harmonised composite kidney endpoint
Methodological detailsrandom-effects pairwise meta-analyses, frequentist network meta-analysis, GRADE certainty assessment
- Random-effects pairwise meta-analyses
- Frequentist network meta-analysis
- GRADE certainty assessment
Pooled result
As reported in the abstract
GLP-1 RAs vs PlaceboHazard ratio (95% CI)
MACE; high certainty
0.84(0.79–0.89)
Composite kidney endpoint; high certainty
0.79(0.73–0.86)
Further pooled results
Kidney failure
- Kidney failure risk reduced by 28%
- HR 0.72
UACR
- UACR decreased by 26%
Effect by SGLT2i background use
- Benefits consistent irrespective of SGLT2i background use
- interaction p = 0.41
NMA ranking
- Semaglutide ranked highest in the NMA
- SUCRA 78.4%
Safety
- No excess acute kidney injury risk was observed
Original publication
Efficacy and Safety of GLP ‐1 Receptor Agonists on Combined Cardiovascular and Renal Outcomes in Patients With Chronic Kidney Disease: A Systematic Review and Meta‐Analysis. Diabetes Obes Metab. Published 23 June 2026. doi:10.
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