Effects of GLP‐1 receptor agonists on cardiovascular outcomes in patients with type 2 diabetes and chronic kidney disease: A systematic review and meta‐analysis

AIM: To evaluate the cardiovascular outcomes of glucagon‐like peptide‐1 receptor agonists (GLP1‐RA) in patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). MATERIALS AND METHODS: We searched PubMed, Ovid MEDLINE, CINAHL, and Web of Science databases for randomized controlled trials reporting event rates for a composite cardiovascular outcome of cardiovascular death, myocardial infarction, and stroke in patients with T2DM and CKD receiving GLP1‐RA or placebo. Studies were restricted to those reporting specific event rates for patients with CKD separately from the overall population. We conducted a meta‐analysis using a random‐effects model. This meta‐analysis was registered on PROSPERO (CRD42022320157). RESULTS: A total of four studies comprising 7130 patients was included in our analysis. Four different GLP1‐RA were assessed in a population with CKD defined as estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m(2). Treatment with GLP1‐RA was not associated with a significant reduction in the composite cardiovascular end point of cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke (odds ratio (OR) 0.80; 95% confidence interval (CI), 0.59–1.07; p = 0.13) among patients with T2DM and CKD. Individual components of the composite cardiovascular end point were assessed in two trials and did not show evidence of an effect of GLP1‐RA in reducing cardiovascular end points. CONCLUSIONS: Pooled analysis of clinical trials reporting separate cardiovascular events rates in patients with T2DM and CKD did not find GLP1‐RA to be associated with a reduction in composite cardiovascular event rates. Select GLP1‐RA may offer cardiovascular event reduction in patients with T2DM and CKD, but this does not appear to be a class effect. Use of GLP1‐RA with demonstrated cardiovascular benefits should be preferred in patients with CKD and T2DM to further reduce cardiovascular risk.