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Glucagon-Like Peptide 1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors Improve Renal Resistive Index

Alfredo Vozza1, Sara Volpe1, Carlo Custodero1

  • 1Interdisciplinary Department of Medicine, School of Medicine, University of Bari "Aldo Moro", Bari, Italy.

Journal of Diabetes Research
|February 18, 2025
PubMed

Insights

Glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) significantly improve renal resistive index (RRI) in patients with Type 2 diabetes. This suggests these therapies offer benefits for cardiovascular risk and kidney outcomes.

Area of Science:

  • Nephrology
  • Endocrinology
  • Cardiology

Background:

  • Diabetic kidney disease (DKD) is a severe complication of diabetes, leading to chronic kidney disease.
  • Renal resistive index (RRI) is a Doppler ultrasound measure for assessing kidney health in DKD.
  • Glucagon-like peptide 1 receptor agonists (GLP1-RAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2is) are emerging treatments for Type 2 diabetes (T2D) with potential renal benefits.

Purpose of the Study:

  • To investigate the effect of GLP1-RA and SGLT2i therapies on RRI in T2D patients.
  • To explore the relationship between RRI and key glycometabolic parameters.
  • To assess RRI changes as an indicator of early kidney damage and treatment response.

Main Methods:

  • A 26-week prospective study involving 145 T2D patients.
  • Patients received GLP1-RA (dulaglutide/semaglutide), SGLT2i, or other therapies (control group).
  • RRI, albuminuria, and estimated-glomerular filtration rate (e-GFR) were measured at baseline and 6 months.

Main Results:

  • At baseline, RRI correlated positively with age, glucose, HbA1c, triglycerides, and albuminuria, and negatively with e-GFR.
  • GLP1-RA and SGLT2i treatments significantly improved RRI compared to baseline and controls.
  • RRI improvement occurred independently of changes in BMI, HbA1c, or e-GFR, with normalization in 30-32% of patients on these therapies.

Conclusions:

  • RRI is a valuable tool for detecting early kidney damage in DKD and monitoring treatment efficacy.
  • GLP1-RAs and SGLT2is demonstrate significant benefits on RRI, indicating positive impacts on cardiovascular risk and renal outcomes.
  • RRI changes may serve as an early indicator of renal improvement in T2D patients treated with GLP1-RAs or SGLT2is.
Keywords:
Type 2 diabeteschronic kidney diseasediabetic kidney diseaseglucagon-like peptide 1 receptor agonistsrenal Doppler ultrasoundrenal damagerenal hemodynamicrenal resistive indexsodium–glucose cotransporter 2 inhibitors

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