Gerry George MATHEW
Turkish Journal of Nephrology - 2026;35(3):182-193
Diabetic nephropathy (DN) remains the predominant etiology of chronic kidney disease (CKD) worldwide, significantly resulting in mortality and morbidity among individuals with diabetes mellitus. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have surfaced as transformative treatment options, offering multifaceted benefits that extend beyond glycemic control. This article explores the comprehensive role of GLP-1RAs in renoprotection and their impact on the progression of DN. Glucagon-like peptide-1 receptor agonists exhibit significant renoprotective effects through multiple mechanisms, including glycemic optimization (HbA1c reduction of 0.73%-3.01%), substantial weight reduction (14%-16% in leading clinical trials), blood pressure reduction (2-6 mmHg systolic reduction), anti-inflammatory effects, and direct albuminuria reduction (11.74%-33%). Major clinical trials, including Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes (SUSTAIN-6), Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results (LEADER), Evaluate Renal Function with Semaglutide Once Weekly (FLOW), Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND), consistently demonstrate cardiovascular benefits and slowed CKD progression. Glucagon-like peptide-1 receptor agonists signify a vital shift in the management of diabetic kidney disease, offering comprehensive metabolic benefits with established renoprotective and cardiovascular advantages.
