GLP-1-RA – „New kid on the block“ in der Nephrologie?

Was ist neu?

Inkretine

GLP-1 ist ein Inkretinhormon, das die Insulinsekretion stimuliert, die Glukagonfreisetzung hemmt und weitere metabolische Prozesse beeinflusst. GLP-1-Rezeptoragonisten (GLP-1-RA) rücken zunehmend in den Fokus der Nephrologie, insbesondere im Kontext der chronischen Nierenerkrankung (CKD) bei Patienten mit Typ-2-Diabetes mellitus (T2DM). Ursprünglich als Antidiabetika entwickelt, zeigen sie neben ihrer blutzuckersenkenden Wirkung auch kardiovaskuläre und nephroprotektive Effekte.

GLP-1-Rezeptoragonisten

Bei T2DM-Patienten ist die Funktion dieses Systems beeinträchtigt, was zur Entwicklung spezifischer, langwirksamer GLP-1-RA geführt hat. Sie führen zu einer HbA_1c-Reduktion von bis zu 1,9% und weisen im Vergleich zu Insulin ein geringeres Hypoglykämierisiko auf. Auch in der Adipositastherapie spielen sie eine zunehmend zentrale Rolle. Über zentrale Mechanismen im Hypothalamus sowie periphere Effekte, wie die Verzögerung der Magenentleerung, senken sie das Körpergewicht. Darüber hinaus belegen große kardiovaskuläre Endpunktstudien, dass GLP-1-RA das Risiko für kardiovaskuläre Ereignisse signifikant reduzieren.

Nephroprotektion

Erste Hinweise auf nephroprotektive Effekte von GLP-1-RA stammen aus diesen kardiovaskulären Endpunktstudien. Die FLOW-Studie untersuchte erstmals gezielt die nephroprotektiven Effekte von Semaglutid bei Patienten mit CKD und T2DM und konnte beeindruckende, nephroprotektive Ergebnisse aufzeigen. Die aktuelle Studienlage bestätigt auch die nephroprotektiven Effekte von GLP-1-RA bei CKD-Patienten mit T2DM, und weitere Evidenz für ihren Einsatz wird erwartet. Besonders bedeutsam wird die Frage sein, ob auch CKD-Patienten ohne begleitenden T2DM von einer GLP-1-RA-Therapie profitieren oder ob die Kombination mit SGLT2-Inhibitoren additive nephroprotektive Effekte bietet. Die Entwicklung von GLP-1-RA ist ein bedeutender Fortschritt, erfordert jedoch eine enge interdisziplinäre Zusammenarbeit und optimierte Versorgungsstrukturen, um Hochrisikopatienten bestmöglich zu behandeln.

Abstract

GLP-1 receptor agonists (GLP-1-RA) are emerging as promising agents beyond their established role in type 2 diabetes mellitus (T2DM) and obesity treatment, showing significant nephroprotective effects. The FLOW study demonstrated that semaglutide significantly slows the progression of chronic kidney disease (CKD) in T2DM patients. The nephroprotective mechanisms are multifactorial, including improved glycemic control, blood pressure reduction, antifibrotic, and anti-inflammatory effects. Early studies suggest that GLP-1-RA may also benefit patients without T2DM. Additionally, their combination with SGLT2 inhibitors is gaining relevance. Current evidence suggests that GLP-1-RA could play a key role in CKD management. Future studies will determine whether they can be established as a standard therapy to optimize care for high-risk patients.

Schlüsselwörter

Inkretine - GLP-1-Rezeptor Agonisten - Nephroprotektion

Keywords

incretins - GLP1-agonist - pharmacological nephroprotection

Publication History

Article published online:
19 May 2025

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