OBJECTIVE  To systematically evaluate the efficacy and safety of glucagon-like peptide-1 receptor agonists(GLP-1RA) in the renal protection of type 2 diabetes(T2DM) patients, and provide evidence for clinic.

METHODS  Computer retrieval of PubMed, Embase, The Cochrane Library, Clinical Trials.gov, CNKI, WanFang Data and VIP databases, and manual retrieval of the included references. Randomized controlled trials(RCTs) for T2DM using GLP-1RA alone or GLP-1RA in combination with other conventional agents(experimental group) versus conventional treatment without GLP-1RA or placebo(control group). The search period spanned from the establishment of the database to January 30, 2022. Meta-analysis of the included data was performed using RevMan 5.4 statistical software.

RESULTS  A total of 7 studies were included, including 7 985 cases in experimental group and 6 633 cases in control group. Meta-analysis showed that the experimental group significantly reduced the incidence of renal complex endpoint eventsZ=2.17, P=0.03, RR=0.79, 95%CI(0.64, 0.98), urinary albumin creatinine ratioZ=11.66, P<0.00001, MD=–23.74, 95%CI(–27.73, –19.74), incidence of new macroalbuminuriaZ=5.79, P<0.000 01, MD=0.76, 95%CI(0.69, 0.83), hemoglobin A1cZ=12.76, P<0.000 01, MD=–0.94, 95%CI(–1.09, –0.80) and estimated glomerular filtration rateP=0.0007, Z=3.39, MD=–7.37, 95%CI(–11.63, –3.10), the differences were statistically significant. One study showed that the experimental group could significantly reduce 24-hour urinary albumin excretion rate. However, there was no significant difference in the incidence of acute renal failure between the two groupsZ=0.63, P=0.53, MD=1.13, 95%CI(0.78, 1.63). In terms of safety, except the incidence of hypoglycemia, the incidence of adverse reactions in the experimental group was higher than that in the control group, including diarrhea, nausea, vomiting and loss of appetite, with statistically significant differences.

CONCLUSION  Existing research evidence shows that the common adverse reactions of GLP-1RA are gastrointestinal reactions and can be tolerated. Compared with placebo or conventional treatment without GLP-1RA, GLP-1RA may have a protective effect on the kidney of T2DM patients, and this conclusion needs to be further verified by RCTs.