What is the role of GLP-1 agonists in the treatment of diabetic nephropathy?

Updated: Oct 09, 2019
  • Author: Vecihi Batuman, MD, FASN; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The GLP-1 agonists exenatide (Byetta) and liraglutide (Victoza) are also known as injectable incretin mimetics. These drugs enhance central satiety and reduce appetite, thus helping with weight loss. These drugs promote insulin release, delay glucagon release, and slow gastric emptying and are less likely to cause hypoglycemia. There is some concern, however, about safety, as they may cause pancreatitis. Exenatide clearance is GFR dependent and is reduced at low GFRs. [33]

Although disputed, there are cases of acute renal failure associated with exenatide, and it is recommended to be used with caution in patients with a GFR of 30-50 mL/min and not be used at all if the eGFR is less than 30 mL/min. Liraglutide is not metabolized by the kidney, and no dose adjustment is necessary in patients with a decreased GFR, including ESRD, although data in this population are limited. [34] Cases of acute renal failure and worsening of chronic renal impairment have been reported with liraglutide, and the manufacturer advises caution in initiating or increasing the dose in patients with kidney disease.


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