The Role of GLP-1 Receptor Agonists (Ozempic and Mounjaro) as Secondary Therapy in Chronic Kidney Disease

Resumen

This multicenter study evaluated the role of glucagon-like peptide-1 receptor agonists (GLP-1RAs), specifically semaglutide and tirzepatide, as secondary therapy in patients with type 2 diabetes mellitus (T2DM) and chronic kidney disease (CKD). A total of 3,000 adults (mean age 61 years, 46% women) were enrolled across centers in Mexico, Colombia, and Ecuador and were randomized to GLP-1RA therapy or standard care. Baseline characteristics, including obesity, hypertension, dyslipidemia, and moderate CKD (mean eGFR ~55 mL/min/1.73 m²), were well balanced between groups. Over a 36-month follow-up, GLP-1RA therapy was associated with a slower decline in renal function (final eGFR 52.8 vs. 50.2 mL/min/1.73 m²), a lower incidence of composite renal outcomes (15.2% vs. 22.8%), and greater reductions in albuminuria (−35% vs. −14%). In addition, participants receiving GLP-1RAs experienced fewer major adverse cardiovascular events (11.5% vs. 15.9%), improved glycemic control (HbA1c reduced from 8.2% to 7.0% vs. 7.7% in controls), and sustained weight loss (−8 kg vs. −2 kg). Safety outcomes showed higher rates of gastrointestinal adverse events but lower hypoglycemia risk and no significant difference in pancreatitis. These findings demonstrate that GLP-1RAs provide integrated renal, cardiovascular, and metabolic benefits, supporting their inclusion as part of comprehensive therapy for high-risk patients with T2DM and CKD.