Renal Outcomes of GLP-1 Receptor Agonists (Semaglutide and Tirzepatide) in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Multicenter Latin American Study

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Abstract
The growing prevalence of diabetic kidney disease (DKD) underscores the urgent need for therapies that go beyond glycemic control to achieve meaningful renal protection. This multicenter international study evaluated the impact of GLP-1 receptor agonists—semaglutide (Ozempic) and tirzepatide (Mounjaro)—on kidney outcomes in adults with type 2 diabetes mellitus and chronic kidney disease across Mexico, Colombia, and Ecuador. A total of 1,200 participants were followed for 12 months and compared with matched controls under standard care. Both semaglutide and tirzepatide significantly reduced the incidence of the composite renal endpoint (≥40% decline in eGFR, renal replacement therapy, or cardiovascular death) by 22% and 26%, respectively, versus control. The annual decline in estimated glomerular filtration rate was markedly slower in treated groups (−1.2 to −1.3 mL/min/1.73m²/year) compared with standard care (−3.4 mL/min/1.73m²/year), and urinary albumin-to-creatinine ratio decreased by 35–40%. These benefits were consistent across subgroups, including sex, age, CKD stage, and country, and remained significant after adjustment for confounders. The nephroprotective effects observed likely reflect multifactorial mechanisms—hemodynamic stabilization, anti-inflammatory modulation, endothelial protection, and synergy with SGLT2 inhibitors and RAAS blockade. Results parallel those from major global trials such as FLOW, SURPASS-4, and REWIND, confirming reproducible benefits in Latin American populations. Integrating GLP-1 receptor agonists into diabetic kidney disease management may represent a transformative, evidence-based strategy to delay renal failure and reduce cardiovascular mortality worldwide.

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