肾移植受者的 GLP-1 激动剂:当前证据和未来研究方向综述》。

IF 1.6 Q3 UROLOGY & NEPHROLOGY
Canadian Journal of Kidney Health and Disease Pub Date : 2024-10-31 eCollection Date: 2024-01-01 DOI:10.1177/20543581241290317
Victoria J Riehl-Tonn, Kyle D Medak, Christie Rampersad, Anne MacPhee, Tyrone G Harrison
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引用次数: 0

摘要

审查目的:在接受肾移植的患者中,糖尿病是导致肾脏疾病的最常见原因,而没有糖尿病的患者在接受肾移植后患糖尿病的风险更大。最近,一类名为胰高血糖素样肽-1受体激动剂(GLP-1RA)的糖尿病治疗药物被广泛用于糖尿病或肥胖症患者,其疗效包括改善血糖控制、减轻体重和降低心血管事件风险。鉴于这些益处以及肾移植受者中经常出现的适应症,在这一人群中使用 GLP-1RAs 值得考虑。因此,我们试图回顾目前的文献,以更好地了解 GLP-1RA 在肾移植受者中的作用机制、临床应用以及以人为本的考虑因素:采用 "肾移植"、"GLP-1"、"胰高血糖素样肽-1 受体激动剂 "和 "糖尿病 "等术语,从 Ovid MEDLINE 数据库、PubMed 和 Google Scholar 等电子数据库中查找 2023 年 12 月至 2024 年 7 月间的原创文章:我们对文献进行了全面回顾,以探讨 GLP-1RA 与肾移植受者之间的关系。我们回顾了基础或基本科学、临床和健康服务研究以及以人为本的公平科学等研究学科的证据现状,并强调了为未来研究提供机会的重要知识缺口:大量临床研究表明,GLP-1RAs 可为糖尿病肾病患者或非糖尿病肾病患者带来益处,包括降低心血管事件风险。然而,对肾移植受者使用 GLP-1RA 进行分析的高质量随机对照试验和观察性研究却很少。因此,在这一人群中获益的证据仅限于小型研究,或根据在非移植人群中进行的研究推断。临床前研究和临床研究中越来越多的证据可能会阐明 GLP-1RAs 的肾脏保护机制,并消除这些药物在移植受者人群中应用的障碍。女性、非白人、社会经济地位较低、生活在农村社区的人患糖尿病的风险更大,对 GLP-1RAs 的吸收率也更低。需要对不同的肾移植人群进行临床试验,以评估 GLP-1RA 对重要健康结果的疗效:本综述的搜索策略可能无法识别所有相关文章。我们的搜索仅限于英语文章。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
GLP-1 Agonism for Kidney Transplant Recipients: A Narrative Review of Current Evidence and Future Directions Across the Research Spectrum.

Purpose of review: Diabetes is the most common cause of kidney disease in individuals that receive a kidney transplant, and those without pre-existing diabetes are at greater risk of developing diabetes following kidney transplant. A class of diabetes treatment medications called glucagon-like peptide-1 receptor agonists (GLP-1RA) has seen recent widespread use for people with diabetes or obesity, with efficacy for improved glycemic control, weight loss, and reduced risk of cardiovascular events. Given these benefits, and indications for use that often co-occur in kidney transplant recipients, use of GLP-1RAs warrants consideration in this population. Therefore, we sought to review the current literature to better understand the mechanisms of action, clinical application, and person-centred considerations of GLP-1RAs in kidney transplant recipients.

Sources of information: Original articles were identified between December 2023 and July 2024 from electronic databases including the Ovid MEDLINE database, PubMed, and Google Scholar using terms "kidney transplant," "GLP-1," "glucagon-like peptide-1 receptor agonist," and "diabetes."

Methods: A comprehensive review of the literature was conducted to explore the relationship between GLP-1RAs and kidney transplant recipients. We reviewed the current state of evidence across the research disciplines of basic or fundamental science, clinical and health services research, and person-centred equity science, and highlighted important knowledge gaps that offer opportunities for future research.

Key findings: Numerous clinical studies have demonstrated the benefit of GLP-1RAs in people with and without diabetic kidney disease, including decreased risk of cardiovascular events. However, there is a paucity of high-quality randomized controlled trials and observational studies analyzing use of GLP-1RAs in kidney transplant recipients. Evidence of benefit in this population is therefore limited to small studies or inferred from research conducted in nontransplant populations. Growing evidence from preclinical and clinical studies may elucidate renoprotective mechanisms of GLP-1RAs and remove barriers to application of these drugs in the transplant recipient population. Individuals who are female, non-white, have lower socioeconomic status, and live in rural communities are at greater risk of diabetes and have lower uptake of GLP-1RAs. There is a need for clinical trials across diverse kidney transplant populations to estimate the efficacy of GLP-1RAs on important health outcomes.

Limitations: The search strategy for this narrative review may not have been sensitive to identify all relevant articles. Our search was limited to English language articles.

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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
84
审稿时长
12 weeks
期刊介绍: Canadian Journal of Kidney Health and Disease, the official journal of the Canadian Society of Nephrology, is an open access, peer-reviewed online journal that encourages high quality submissions focused on clinical, translational and health services delivery research in the field of chronic kidney disease, dialysis, kidney transplantation and organ donation. Our mandate is to promote and advocate for kidney health as it impacts national and international communities. Basic science, translational studies and clinical studies will be peer reviewed and processed by an Editorial Board comprised of geographically diverse Canadian and international nephrologists, internists and allied health professionals; this Editorial Board is mandated to ensure highest quality publications.
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