GLP-1 Receptor Agonists in Chronic Kidney Disease: Nephroprotection Beyond Glycemic Control - A Review of Current Literature

Background: Chronic Kidney Disease (CKD) is currently one of the major global health burdens and the number of people affected by this disease is still rising. CKD is strongly associated with type 2 diabetes mellitus (T2DM), obesity and cardiovascular diseases. Despite the fact that glucagon-like-peptide-1 receptor agonists were primarily developed as glucose-lowering agents, accumulating evidence suggests that their benefits extend beyond glycemic control and include significant renoprotective effects. Aim: This review synthesises current evidence on the nephroprotective effects of GLP-1 receptor agonists in patients with CKD with emphasis on clinical trials outcomes and future therapeutic perspectives. Materials and Methods: A narrative review of current literature was conducted in PubMed, Google Scholar, and Scopus. Relevant randomized controlled trials, meta-analyses, and recent review articles published between 2019 and 2026 were analyzed. Results: GLP-1 receptor agonists expend nephroprotective effects through multiple pathways, including reduction of systemic inflammation, oxidative stress, endothelial dysfunction, albuminuria and intraglomerular hypertension. Additional benefits arise from weight reduction, blood pressure lowering and cardiovascular protection. Clinical trials such as LEADER, SUSTAIN-6, REWIND, and particularly the FLOW trial demonstrated significant reductions in renal composite outcomes and slower decline in estimated glomerular filtration rate (eGFR). The FLOW trial provided the first dedicated evidence that semaglutide significantly reduces the risk of kidney disease progression and cardiovascular death in patients with T2DM and CKD. Conclusions: Current evidence suggests that GLP-1 receptor agonists represent an emerging nephroprotective therapy with benefits extending far beyond glycemic control. Their pleiotropic effects may position GLP-1 RAs as an important component of future cardio–renal–metabolic management strategies in CKD patients. Further studies are needed to clarify their role in non-diabetic CKD and advanced kidney disease.