Chronic kidney disease (CKD), characterized by a reduced estimated glomerular filtration rate (eGFR) or the presence of albuminuria and/or other markers of kidney damage for over 3 months, is a common complication of type 2 diabetes mellitus (T2DM) associated with high morbidity and mortality.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a safe and effective treatment for T2DM that augment insulin secretion and suppress glucagon release via the stimulation of GLP-1 receptors.

Evidence from several large clinical studies indicate that GLP-1 RA therapy is safe for people living with T2DM and compromised renal function and may have renoprotective properties mediated via direct and indirect mechanisms; however, despite evidence of safety and efficacy, and the low risk of hypoglycemia, GLP-1 RA use is uncommon in people living with T2DM and renal impairment.

We review the evidence of GLP-1 RA use in people living with T2DM and CKD and summarize the renal outcomes from key clinical studies. We also provide practical considerations for GLP-1 RA use to provide an added benefit to guide treatment in this high-risk patient population.

The current evidence indicates that GLP-1 RA could add to the arsenal available that addressing persistent gaps in the care of people living with T2DM with or at the risk of developing CKD while reducing the residual renal risk present in those who have already developed CKD.