The Effectiveness And Safety Of Liraglutide In The Treatment Of Diabetic Nephropathies:A Meta-Analysis

Background and Aim:Diabetic nephropathy(DN)is one of the major complications of diabetes,and its incidence has reached 20% to 40% of people with diabetes.It is the main cause of end-stage renal disease(ESRD)[1].At present,the main purpose of clinical treatment is to control the blood glucose level and delay the progression of DN.For patients with DN,it is of great practical significance to choose a hypoglycemic drug reasonably to effectively control blood glucose and protect the kidneys.Glucagon-like peptide-1receptor agonists(GLP-1 RA),as one of the new hypoglycemic agents,have received increasing attention for their renal protective effects and deserve further exploration.Therefore,we searched the literature on GLP-1 RA representing liraglutide(LIR)for diabetic nephropathy,in order to evaluate the efficacy and safety of GLP-1 RA in the treatment of DN.Retrieval literature in Chinese and foreign databases of Cochrane Library,Pub Med,Medline,Embase,China biomedical database,CNKI,wip and wanfang by computer,from January 2000 to December 2019,no language restrictions.Retrieve the title or keywords contained�Diabetic Nephropathies�?�diabetic kidney disease�?�Chronic Kidney Disease�?�Glucagon-Like Peptide 1�?�Liraglutide�?�Victoza�related literature.Collect Randomized Controlled Trial(RCT)for LIR treatment of DN,conduct literature screening according to the exclusion and inclusion criteria,conduct quality evaluation and data extraction of the selected literature,and use Rev Man5.3 and Stata 12.0 software to perform meta-analysis.Results:A total of 1291 DN patients were enrolled in 11 eligible clinical studies.Meta analysis results show that in the treatment of DN in the LIR group,reducing urinary albumin excretion rates(UAER;MD=-15.09,95% CI [-18.64,-11.53]),urinary albumin to creatinine ratio(UACR;MD =-10.75,95% CI [-11.41,-10.9]),24-hour proteinuria(SMD=-0.67,95% CI [-0.85,-0.48]),Blood urea nitrogen(BUN;MD =-2.05,95% CI [-2.30,-1.79]),serum creatinine(Scr;MD=-11.75,95% CI [-14.19,-9.30]),glycated hemoglobin(Hb A1c;SMD=-0.74,95% CI [-1.05,-0.42]),fasting blood glucose(FBG;MD =-0.64,95% CI [-0.92,-0.36]),body mass index(BMI;MD=-3.06,95% CI [-4.01,-2.12]),triacylglycerol(TG;MD =-0.30,95% CI[-0.33,-0.26]),interleukin-6(IL-6;SMD =-1.08,95% CI [-1.35,-0.82]),tumor necrosis factor-?(TNF-?;SMD =-0.54,95% CI [-0.75,-0.33])were better than the control group,P <0.05.However,the LIR group and the control group had no significant difference in reducing total cholesterol(TC;MD =-0.40,95% CI [-1.22,-0.42],P = 0.34)and the incidence of adverse reactions(RR=0.86,95% CI[ 0.42,1.77],P=0.67).Conclusion:For patients of diabetic nephropathy,Liraglutide appears to be effective in reducing proteinuria,improving renal function,producing an anti-inflammatory effect and ameliorating glucose and lipid metabolism and does not increase the risk of adverse reactions.